Korean J Gastroenterol.  2011 Feb;57(2):115-119. 10.4166/kjg.2011.57.2.115.

A Case of Synchronous Double Primary Cancer of Gastric Adenocarcinoma and Diffuse Large B Cell Lymphoma

• Park SY
• Eun CS
• Byun YS
• Yoon JY
• Jeon YC
• Han DS
• Sohn JH
• Oh YH

• KMID: 1775841
• DOI: http://doi.org/10.4166/kjg.2011.57.2.115

Abstract

The simultaneous occurrence of primary gastric lymphoma and adenocarcinoma is rarely reported. We here report a case of synchronous double primary tumor of advanced gastric cancer and diffuse large B cell lymphoma. A 65-year-old woman underwent an esophagogastroduodenoscopy for the evaluation of abdominal discomfort of two months' duration. The endoscopic examination showed an ulcerating tumor in the gastric antrum and thickened folds in the fundus and the microscopic examination revealed an adenocarcinoma in the antrum and a diffuse large B-cell lymphoma in the fundus. She has had total gastrectomy and CHOP chemotherapy with rituximab. Since the cases of synchronous double primary gastric tumors have been increased on the recent medical advances, when a gastric tumor is detected for the endoscopic examination, an endoscopist has to make every endeavor not to miss another tumor in the stomach.

Keyword

Synchronous neoplasms; Adenocarcinoma; Lymphoma, Large B-Cell, Diffuse

MeSH Terms

Adenocarcinoma/*diagnosis/drug therapy/pathology
Aged
Antibodies, Monoclonal, Murine-Derived/therapeutic use
Antineoplastic Combined Chemotherapy Protocols/therapeutic use
Cyclophosphamide/therapeutic use
Doxorubicin/therapeutic use
Endoscopy, Digestive System
Female
Gastrectomy
Humans
Lymphoma, Large B-Cell, Diffuse/*diagnosis/drug therapy/pathology
Neoplasms, Multiple Primary/*diagnosis
Prednisone/therapeutic use
Stomach Neoplasms/*diagnosis/drug therapy/pathology
Tomography, X-Ray Computed
Vincristine/therapeutic use

Figure

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  Fig. 1. Gastroscopic findings. (A) Initial gastroscopic finding showed huge ulcerative mass on the anterior wall of antrum. (B) Gastric mucosal folds were enlarged on the posterior wall of upper body and fundus, and several irregular erosions were seen on that mucosal surface.

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  Fig. 2. Abdominal CT findings. (A) Abdominal CT showed gastric antral wall thickening with 5 cm sized excavating ulcer. (B) It also showed another lobular thickening of gas-tric wall and thickened gastric folds in the cardia and fundus.

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  Fig. 3. Microscopic findings and immunohistochemical stain. Histologic finding of gastric antral mass reveals moderately (A) (H&E,×2) to poorly (B) (H&E, ×100) differentiated adenocarcinoma. The lymphoid cells infiltrated in cardia and fundus have diffusely positive cytoplasmic reaction for (C) CD79a (×40) and (D) CD10 (×400).

Reference

References

1. Amer MH, el-Akkad S. Gastrointestinal lymphoma in adults: clinical features and management of 300 cases. Gastroenterology. 1994; 106:846–858.

2. Ferreri AJ, Montalbán C. Primary diffuse large B-cell lymphoma of the stomach. Crit Rev Oncol Hematol. 2007; 63:65–71.

3. Noda T, Akashi H, Matsueda S, Katsuki N, Shirahashi K, Kojiro M. Collision of malignant lymphoma and multiple early adenocarcinomas of the stomach. Arch Pathol Lab Med. 1989; 113:419–422.

4. Lee YJ, Kim YJ, Choi US, et al. A case of advanced gastric adenocarcinoma with synchronous gastric diffuse large B cell lymphoma. Korean J Gastrointest Endosc. 2010; 40:181–185.

5. Wotherspoon AC, Isaacson PG. Synchronous adenocarcinoma and low grade B-cell lymphoma of mucosa associated lymphoid tissue (MALT) of the stomach. Histopathology. 1995; 27:325–331.

6. Goteri G, Ranaldi R, Rezai B, Baccarini MG, Bearzi I. Synchronous mucosa-associated lymphoid tissue lymphoma and adenocarcinoma of the stomach. Am J Surg Pathol. 1997; 21:505–509.

7. Hamaloglu E, Topaloglu S, Ozdemir A, Oznec A. Synchronous and metachronous occurrence of gastric adenocarcinoma and gastric lymphoma: a review of the literature. World J Gastroenterol. 2006; 12:3564–3574.

8. Prabhash K, Biswas G, Nair R, et al. Metachronous diffuse large B-cell lymphoma and adenocarcinoma. Indian J Gastroenterol. 2006; 25:261–262.

9. Travoto C, Sonzogni A, Ravizza D, et al. Confocal laser endomicroscopy diagnosis of gastric adenocarcinoma in a patient treated for gastric diffuse large-B-cell lymphoma. Dig Liver Dis. 2009; 41:447–449.

10. Seo DB, Kwon KS, Park HS, et al. Metachronous gastric MALT lymphoma and early gastric cancer: a case report. Korean J Gastroenterol. 2007; 49:245–250.

11. Nakamura S, Aoyagi K, Iwanaga S, Yao T, Tsuneyoshi M, Fujishima M. Synchronous and metachronous primary gastric lymphoma and adenocarcinoma: a clinicopathological study of 12 patients. Cancer. 1997; 79:1077–1085.

12. Copie-Bergman C, Locher C, Levy M, et al. Metachronous gastric MALT lymphoma and early gastric cancer: is residual lymphoma a risk factor for the development of gastric carcinoma? Ann Oncol. 2005; 16:1232–1236.

13. Kim JB, Choi MK, Lee JH, et al. Clinicopathologic features of multiple synchronous gastric cancer. J Korean Cancer Assoc. 1998; 30:652–659.

14. Kosaka T, Miwa K, Yonemura Y, et al. A clinicopathologic study on multiple gastric cancers with special reference to distal gastrectomy. Cancer. 1990; 65:2602–2605.

15. Hwang CY, Ryu MH, Kang YK, et al. Complete remission of high grade gastric MALT lymphoma after Helicobacter pylori eradication. Korean J Med. 2004; 66:95–99.

16. Maor MH, Velasquez WS, Fuller LM, Silvermintz KB. Stomach conservation in stages IE and IIE gastric non-Hodgkin's lymphoma. J Clin Oncol. 1990; 8:266–271.

17. GASTRIC (Global Advanced/Adjuvant Stomach Tumor Research International Collaboration) Group. Paoletti X, Oba K, et al. Benefit of adjuvant chemotherapy for resectable gastric cancer: a metaanalysis. JAMA. 2010; 303:1729–1737.

18. Psyrri A, Papageorgiou S, Economopoulos T. Primary extranodal lymphomas of stomach: clinical presentation, diagnostic pitfalls and management. Ann Oncol. 2008; 19:1992–1999.