Korean J Hematol.  2008 Dec;43(4):247-252. 10.5045/kjh.2008.43.4.247.

Metachronous Mantle Cell Lymphoma with Leukemic Presentation in a Patient with Early Gastric Cancer: A Case Report

• Eo WK
• Ahn KJ
• Lee WI
• Lim SJ
• Jeong JS

• KMID: 1485083
• DOI: http://doi.org/10.5045/kjh.2008.43.4.247

Abstract

We report here on a case of metachronous second primary non-Hodgkin's lymphoma (NHL) that was diagnosed 6 years after performing subtotal gastrectomy for treating early gastric cancer (EGC). The subtype analysis revealed mantle cell lymphoma (MCL) of the blastic variant with a leukemic presentation, which was composed of mixed small and medium-sized cells. The immunohistochemical staining for cyclin-D1 was positive. The cytogenetic study revealed t(4;6). In Korea, the risk of developing a second primary cancer following gastric cancer was reported to be less than 3.4%, and NHL comprised less than 6.3% of this second primary cancer. Furthermore, MCL represents about 2% of all lymphomas in Korea. To the best of our knowledge, this is the first report of metachronous primary MCL with a leukemic presentation following curative resection of EGC.

Keyword

Gastric cancer; Metachronous second primary neoplasms; Mantle cell lymphoma; Leukemia

MeSH Terms

Cytogenetics
Gastrectomy
Humans
Korea
Leukemia
Lymphoma
Lymphoma, Mantle-Cell
Lymphoma, Non-Hodgkin
Neoplasms, Second Primary
Stomach Neoplasms

Figure

• 

  Fig. 1 The increased FDG uptake in the axial skeleton of whole body is noted. The multifocal increase of FDG uptake in multiple lymph node areas including jugular, paratracheal, internal mammary, subcarinal, hilar, anterior and middle diaphragmatic, portocaval, paraaortic, iliac, inguinal, and mesenteric lymph node areas is noted. The increase of FDG uptake in the liver and spleen is also seen.

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  Fig. 2 The microscopic examination of the lymph node from the inguinal area shows diffuse proliferation of small to medium-sized lymphoid cells with irregular nuclear contour, and admixed lymphoid cells with dispersed chromatin resembling lymphoblasts (H-E stain, ×200) (A). The immunohistochemical staining for cyclin-D1 reveals positive result (×400) (B).

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  Fig. 3 (A) The Bone marrow aspiration shows many blast cells of small to medium size with dispersed chromatin, high nucleus/cytoplasmic ratio and prominent nucleoli (Wright stain, ×1,000). (B) Cytogenetic study shows chromosomal abnormality of 46,XY, t(4;6)(q21.2;q23.2)[3]/46,XY[37].

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