{"schema":"https://ver.cy/schemas/card/1.0.0","id":"vr.tr.malt-lymphoma","code":"thing-q591256","url":"https://ver.cy/models/thing/q591256/","name":"MALT lymphoma","alternateNames":["breast mucosa-associated lymphoid tissue lymphoma","gastric mucosa-associated lymphoid tissue lymphoma","small intestinal mucosa-associated lymphoid tissue lymphoma","thyroid gland mucosa-associated lymphoid tissue lymphoma"],"kind":"thing","status":"published","version":"0.1.0-research.1","language":"en","classifiers":{"family":"Thing Registry","category":"Information and virtual systems","entryKind":"thing","plane":"INF","domain":["INF.KNW"],"industry":[],"navPath":"","tags":[],"facets":{}},"whatItIs":"MALT lymphoma is an extranodal marginal zone lymphoma of mature B cells arising in mucosa-associated lymphoid tissue, often in settings of chronic antigenic stimulation, and usually following an indolent clinical course.","purpose":"Enable an agent to recognise MALT lymphoma, assess the evidence for its site-specific disease state, and identify questions requiring specialist management decisions.","scope":{"in":["Diagnostic evidence for extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue","Gastric and extragastric sites, multifocal involvement and dissemination","Infectious and autoimmune associations with explicitly qualified causal evidence","Molecular findings relevant to classification and treatment response","Site-specific management prerequisites and response assessment","Persistence, relapse and suspected histological transformation"],"out":["Nodal and splenic marginal zone lymphoma as independent disease entities","Reactive lymphoid hyperplasia and inflammatory disease without established lymphoma","Helicobacter pylori infection and autoimmune disorders beyond their relationship to the lymphoma","Diffuse large B-cell lymphoma treatment, including after confirmed transformation","Primary cutaneous marginal zone entities classified separately by the applicable classification","General patient records, drug prescribing protocols and procedural execution"],"boundaries":[]},"distinguishingFeatures":["Establish an extranodal marginal zone B-cell neoplasm through integrated pathology and anatomical context; extranodal involvement by another lymphoma is insufficient. [NCI SEER](https://seer.cancer.gov/seertools/hemelymph/51f6cf57e3e27c3994bd534b/?q=cytoid)","Interpret B-cell markers and exclusion markers together: CD20 positivity with usual CD5, BCL6 and cyclin D1 negativity supports the differential but is not a standalone diagnostic rule. [NCI SEER](https://seer.cancer.gov/seertools/hemelymph/51f6cf57e3e27c3994bd534b/?q=cytoid)","Separate gastric from extragastric disease because H. pylori eradication can induce gastric lymphoma regression and is not a universal MALT lymphoma treatment. [NCI PDQ](https://www.cancer.gov/types/lymphoma/hp/indolent-b-cell-lymphoma-treatment-pdq)","Record t(11;18)/BIRC3::MALT1 when tested as a molecular finding; do not make its presence mandatory for recognition. [NCI SEER](https://seer.cancer.gov/seertools/hemelymph/51f6cf57e3e27c3994bd534b/?q=cytoid)"],"structure":{"bundles":[{"id":"malt-identity-and-diagnostic-boundaries","name":"MALT identity and diagnostic boundaries","description":"Establish what evidence makes an extranodal lymphoid lesion an instance of this registered disease.","layers":[{"id":"tissue-based-recognition","name":"Tissue-based recognition","description":"Connect the diagnostic interpretation to representative tissue and its limitations.","findings":[{"id":"integrated-pathology-evidence","name":"Integrated pathology evidence","description":"Record morphology, lymphoepithelial involvement where assessable, immunophenotype, ancillary studies and the reviewing pathologist's conclusion.","questions":[{"text":"Which combined morphological and immunophenotypic findings support MALT lymphoma rather than reactive inflammation or another small B-cell lymphoma?","id":"integrated-pathology-evidence-q01","kind":"definition"},{"text":"Which specimen, sampling sites and expert review support the diagnosis, and what limitations remain?","id":"integrated-pathology-evidence-q02","kind":"provenance"}]}]},{"id":"classification-and-neighbouring-entities","name":"Classification and neighbouring entities","description":"Preserve the distinction between disease identity, spread and terminology.","findings":[{"id":"entity-boundary-adjudication","name":"Entity boundary adjudication","description":"Document the classification used and resolve competing marginal zone or other B-cell diagnoses.","questions":[{"text":"What supports extranodal origin rather than nodal or splenic marginal zone lymphoma with secondary organ involvement?","id":"entity-boundary-adjudication-q01","kind":"boundary"},{"text":"Does the classification edition place this presentation within MALT lymphoma or a separately recognised entity, particularly for primary skin disease?","id":"entity-boundary-adjudication-q02","kind":"boundary"}]}]}]},{"id":"organ-distribution-and-clinical-burden","name":"Organ distribution and clinical burden","description":"Describe the disease's anatomical footprint and consequences at each involved site.","layers":[{"id":"local-organ-involvement","name":"Local organ involvement","description":"Capture the lesion features that determine local consequences.","findings":[{"id":"site-specific-lesion-map","name":"Site-specific lesion map","description":"Record lesion location, dimensions, multiplicity, invasion and threatened organ function.","questions":[{"text":"For gastric disease, what do mapped biopsies and any endoscopic ultrasound establish about distribution and wall depth?","id":"site-specific-lesion-map-q01","kind":"measurement"},{"text":"For the involved organ, what evidence establishes bleeding, obstruction, visual compromise, respiratory impairment or another functional threat?","id":"site-specific-lesion-map-q02","kind":"measurement"}]}]},{"id":"systemic-extent","name":"Systemic extent","description":"Distinguish a local presentation from additional extranodal, nodal or marrow disease.","findings":[{"id":"extent-and-staging-confidence","name":"Extent and staging confidence","description":"Retain the staging convention, evidence for each involved compartment and unresolved findings.","questions":[{"text":"Which staging system and version were applied, and which confirmed sites determine the assigned stage?","id":"extent-and-staging-confidence-q01","kind":"provenance"},{"text":"Which unassessed or equivocal sites could change the choice between local and systemic management?","id":"extent-and-staging-confidence-q02","kind":"action"}]}]}]},{"id":"antigenic-context-and-molecular-evidence","name":"Antigenic context and molecular evidence","description":"Separate observed infection, inflammatory associations and tumour molecular findings.","layers":[{"id":"infection-and-autoimmunity","name":"Infection and autoimmunity","description":"Qualify site-specific associations and the reliability of their assessment.","findings":[{"id":"documented-antigenic-context","name":"Documented antigenic context","description":"Maintain test provenance and distinguish established patient findings from proposed causal explanations.","questions":[{"text":"Which H. pylori tests were performed, when, and under what medication or sampling conditions that could affect interpretation?","id":"documented-antigenic-context-q01","kind":"provenance"},{"text":"For an extragastric lesion, what supports a proposed infectious or autoimmune association in this patient and geographical setting?","id":"documented-antigenic-context-q02","kind":"boundary"}]}]},{"id":"molecular-context","name":"Molecular context","description":"Record molecular results without assigning them universal diagnostic or predictive meaning.","findings":[{"id":"molecular-result-interpretation","name":"Molecular result interpretation","description":"Link BIRC3::MALT1 and other reported alterations to assay quality and the specific clinical question.","questions":[{"text":"Was t(11;18)/BIRC3::MALT1 assessed, and what specimen, assay and result support the recorded status?","id":"molecular-result-interpretation-q01","kind":"measurement"},{"text":"What evidence supports using this molecular result to inform eradication-response expectations or another management decision at this site?","id":"molecular-result-interpretation-q02","kind":"action"}]}]}]},{"id":"site-dependent-management-decisions","name":"Site-dependent management decisions","description":"Represent the evidence and clinical conditions needed to discuss treatment or observation.","layers":[{"id":"gastric-eradication-pathway","name":"Gastric eradication pathway","description":"Separate an infection-directed intervention from subsequent lymphoma assessment.","findings":[{"id":"eradication-and-reassessment-plan","name":"Eradication and reassessment plan","description":"Record the clinician-selected eradication approach, confirmation plan and lymphoma reassessment schedule.","questions":[{"text":"What current guideline and patient evidence support offering eradication therapy in this gastric presentation?","id":"eradication-and-reassessment-plan-q01","kind":"action"},{"text":"How and when will bacterial eradication and gastric lymphoma response be assessed separately?","id":"eradication-and-reassessment-plan-q02","kind":"measurement"}]}]},{"id":"observation-local-and-systemic-options","name":"Observation, local and systemic options","description":"Expose the factors determining whether and how lymphoma-directed management is needed.","findings":[{"id":"management-choice-prerequisites","name":"Management choice prerequisites","description":"Capture symptoms, extent, progression, organ preservation, previous treatment and patient preferences.","questions":[{"text":"What findings justify observation or active treatment for this site and disease state?","id":"management-choice-prerequisites-q01","kind":"action"},{"text":"How do disease distribution, organ-specific toxicity, prior therapy and patient priorities affect consideration of radiotherapy or systemic treatment?","id":"management-choice-prerequisites-q02","kind":"action"}]}]}]},{"id":"response-persistence-and-transformation","name":"Response, persistence and transformation","description":"Track the disease across reassessment, residual findings and clinically significant change.","layers":[{"id":"response-evidence","name":"Response evidence","description":"Keep modality-specific observations and assessment timing visible.","findings":[{"id":"concordant-and-discordant-response","name":"Concordant and discordant response","description":"Reconcile symptoms, endoscopy, biopsy and imaging without automatically privileging a single result.","questions":[{"text":"Which histological response criteria were used for gastric biopsies, and how long after treatment was assessment performed?","id":"concordant-and-discordant-response-q01","kind":"measurement"},{"text":"If symptoms, endoscopy, imaging and biopsy disagree, what evidence determines the recorded response state and next review?","id":"concordant-and-discordant-response-q02","kind":"action"}]}]},{"id":"relapse-and-histological-change","name":"Relapse and histological change","description":"Distinguish persistent or recurrent MALT lymphoma from another lesion or transformed disease.","findings":[{"id":"change-requiring-reclassification","name":"Change requiring reclassification","description":"Record new-site disease, altered growth behaviour and the evidence needed to revise diagnosis or management.","questions":[{"text":"Does a new lesion represent persistent MALT lymphoma, relapse, an unrelated malignancy or another process, and what tissue evidence resolves this?","id":"change-requiring-reclassification-q01","kind":"boundary"},{"text":"Which clinical changes prompt biopsy for suspected large-cell transformation, and how will a confirmed diagnosis link to the appropriate neighbouring model?","id":"change-requiring-reclassification-q02","kind":"action"}]}]}]},{"id":"evidence-and-external-alignment","name":"Evidence and external alignment","description":"What the world already says about this thing, gathered so the model can be checked against it.","layers":[{"id":"reported-evidence","name":"Reported evidence","description":"Findings from the breadth pass, kept separate from the structural claims.","findings":[{"id":"evidence-confidence-notes","name":"Check these first","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these check these first hold for the sense of MALT lymphoma this model covers, and on what evidence?","id":"evidence-confidence-notes-q01","kind":"provenance"}]},{"id":"evidence-kinds","name":"Kinds and varieties","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these kinds and varieties hold for the sense of MALT lymphoma this model covers, and on what evidence?","id":"evidence-kinds-q01","kind":"provenance"}]},{"id":"evidence-identifiers","name":"Identifiers and schemes","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these identifiers and schemes hold for the sense of MALT lymphoma this model covers, and on what evidence?","id":"evidence-identifiers-q01","kind":"provenance"}]},{"id":"evidence-standards-and-regulation","name":"Standards and regulation","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these standards and regulation hold for the sense of MALT lymphoma this model covers, and on what evidence?","id":"evidence-standards-and-regulation-q01","kind":"provenance"}]},{"id":"evidence-real-world-use","name":"Real-world use","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these real-world use hold for the sense of MALT lymphoma this model covers, and on what evidence?","id":"evidence-real-world-use-q01","kind":"provenance"}]},{"id":"evidence-failure-modes-and-hazards","name":"Failure modes and hazards","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these failure modes and hazards hold for the sense of MALT lymphoma this model covers, and on what evidence?","id":"evidence-failure-modes-and-hazards-q01","kind":"provenance"}]},{"id":"evidence-regional-variation","name":"Regional variation","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these regional variation hold for the sense of MALT lymphoma this model covers, and on what evidence?","id":"evidence-regional-variation-q01","kind":"provenance"}]},{"id":"evidence-neighbours","name":"Neighbouring kinds and how to tell them apart","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these neighbouring kinds and how to tell them apart hold for the sense of MALT lymphoma this model covers, and on what evidence?","id":"evidence-neighbours-q01","kind":"provenance"}]}]}]}]},"agentConduct":{"may":["Describe MALT lymphoma from oncology and pathology sources, stating that course and treatment vary.","Point people to haematology and cancer support services."],"mustNot":["Diagnose or stage a person's lymphoma from symptoms, scans or reports without a clinician.","Recommend, stop or change a person's cancer treatment.","Promote unproven cures or claim that an indolent course means no care is needed.","Disclose a person's cancer diagnosis without their consent."],"requiresHuman":["Any decision on treatment, including watchful waiting."]},"ethics":{"considerations":["A cancer diagnosis brings fear; information must be honest without being alarming or falsely reassuring.","Patients facing serious illness are targets for false cures."],"affectedParties":["People with lymphoma","Families and carers","Clinicians"]},"owners":{"steward":"Nobody owns the disease; the treating haematologist answers for each patient's care.","roles":[],"masterSystems":["Cancer registries"]},"relations":[{"target":"Q7243121","type":"parent","note":"registry parent class"}],"interaction":{"identity":{"applicability":"required","items":["Vercy registry: vr.tr.malt-lymphoma","Wikidata: Q591256 (https://www.wikidata.org/wiki/Q591256)"]},"properties":{"applicability":"not-applicable","items":["Diagnostic certainty: suspected; indeterminate; pathology-confirmed; revised","Extranodal distribution: gastric; ocular adnexal; salivary; thyroid; pulmonary; other specified; multiple sites","Classification provenance: diagnosis linked to classification edition, pathology report and review date","Disease extent: stage with named system and version; involved organs and nodes; marrow status; unknown components","Gastric wall involvement: reported wall layers involved; assessment method; indeterminate; not applicable","H. pylori evidence: detected; not detected; discordant; untested; eradication confirmed; confirmation pending","Associated inflammatory condition: linked infection or autoimmune diagnosis, affected site, evidence and temporal relationship","BIRC3::MALT1 result: detected; not detected; indeterminate; not tested, with specimen and assay","Lesion burden: lesion dimensions in mm, lesion count and dated anatomical mapping","Response state: not assessed; responding; complete response; residual disease; stable disease; progression; relapse, with criteria and date","Transformation assessment: not suspected; suspected; biopsy pending; confirmed; not demonstrated"]},"recognition":{"applicability":"optional","items":["Biopsy microscopy may show small atypical lymphoid cells expanding marginal zones around reactive follicles.","In glandular tissue, lymphoid cells may infiltrate and damage epithelial structures to form lymphoepithelial lesions.","Some specimens show differentiation toward plasma cells, but visual findings require immunophenotypic and clinical correlation."]},"capabilities":{"applicability":"required","items":["Assemble a site-linked diagnostic evidence summary for hematopathology review.","Identify missing or discordant infection tests before interpreting gastric disease as H. pylori-negative.","Map disease extent and flag information needed to compare local and systemic management options.","Track eradication, lymphoma response and treatment toxicity as separate outcomes.","Surface evidence supporting specialist consideration of observation, infection-directed treatment, radiotherapy or systemic therapy.","Flag progression or suspected transformation for reassessment and possible repeat biopsy."]},"hazards":{"applicability":"required","items":["It can transform into a more aggressive lymphoma.","Symptoms in the stomach or other organs can be mistaken for minor illness."]},"interfaces":{"applicability":"required","items":["WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues, World Health Organization and International Agency for Research on Cancer."]},"context":{"applicability":"required","items":["MALT lymphoma is encountered in specialist assessment of lymphoid disease affecting sites such as the stomach, salivary glands, lungs and ocular adnexa.","The diagnosis provides a framework for interpreting tissue findings, disease extent and associated chronic inflammation."]}},"sources":[{"title":"Wikidata item Q591256: MALT lymphoma","url":"https://www.wikidata.org/wiki/Q591256","note":"identity and sense of the item"},{"title":"Wikipedia: MALT lymphoma","url":"https://en.wikipedia.org/wiki/MALT_lymphoma","note":"general description of the item"}],"openQuestions":["Which current classification editions and regional coding systems should govern historical MALT labels, particularly presentations now classified as primary cutaneous marginal zone entities?","What site-specific evidence justifies infection testing or antimicrobial treatment for extragastric MALT lymphoma across different geographical settings?","Which reassessment intervals and escalation criteria best distinguish delayed gastric regression from clinically significant persistent disease after eradication?","When do molecular testing, PET/CT or marrow assessment change management enough to warrant their use in each presentation?","Which surveillance schedules and biopsy triggers best balance late relapse detection, organ-specific risks and the burden of repeated investigations?"],"resources":{"spec":"/models/things/publications/thing-q591256/spec.json"},"provenance":{"origin":"thing registry research (pass 2)","builtFrom":["models/things/publications/thing-q591256/spec.json"],"providers":["Codex"],"researchStatus":"unreviewed","generatedAt":"2026-09-12T11:09:42Z","builder":"tools/build_cards.py@1.0.0"},"completeness":{"sections":{"classifiers":"filled","whatItIs":"filled","purpose":"filled","distinguishingFeatures":"filled","structure":"filled","agentConduct":"filled","ethics":"filled","owners":"filled","relations":"filled","interaction.identity":"filled","interaction.properties":"not-applicable","interaction.recognition":"filled","interaction.capabilities":"filled","interaction.hazards":"filled","interaction.interfaces":"filled","interaction.context":"filled","sources":"filled"},"notes":{"_gate":"Published through the thing publication gate 1.0 on 2026-10-07T10:10:31+00:00: completeness 1.00; sense: Wikidata description; 2 live sources; review by codex: pass","interaction.properties":"Plane INF: no invented physical properties."},"score":1.0}}