Collision tumor of the stomach

In a gastric neoplasm, malignant lymphoma is a relatively rare disease and a malignant lymphoma complicated by a carcinoma is very rarely found in the same stomach. As far as we could determine in a search of the literature, the coexistence of a gastric cancer and a malignant lymphoma was found in only 30 cases including our case and collision was seen in 10 of these. Our report concerns a recent case of malignant gastric lymphoma colliding with II c early gastric cancer, and is followed by a discussion. The patient, a man of 68, had complained of epigastralgia. The case was diagnosed as a gastric malignant lymphoma after an upper gastrointestinal roentgenogram and endoscopy. A biopsy revealed a torous malignant lymphoma (diffuse medium-sized cell type) and an II c early gastric cancer (tub 2) and suggested the collision between them.     

A case of malignant lymphoma of the stomach in which preoperative chemotherapy provided a complete response

We have encountered a case of malignant lymphoma of the stomach in which a complete remission was confirmed in a resected specimen after chemotherapy. A 75-year-old woman complained of vomiting blood. A biopsy from gastric endoscopy indicated malignant lymphoma of diffuse large B-cell type. The patient was assumed to be inoperable due to enlargement of the tumor and lymph node metastasis, and THP-COP chemotherapy was carried out. After four courses of the THP-COP regimen, endoscopic examination revealed a significant tumor reduction. Total gastrectomy and splenectomy with lymph node dissection (D2) were performed after chemotherapy. No tumor cells were detected in any sections of the specimen or regional lymph nodes.     

A case of coexistent multiple malignant lymphomas and early carcinoma of the stomach

A 68-year-old man with multiple malignant lymphomas and early gastric carcinoma in the stomach is described. In the resected stomach, six lesions of malignant lymphoma, large cell type (LSG classification) or histiocytic type (Rappaport classification) were observed at the posterior wall of the gastric body. Well differentiated tubular adenocarcinoma as an early carcinoma of type IIc was also found on the lesser curvature of the gastric body. In addition, multiple early follicular proliferation of malignant lymphoma was microscopically revealed centering around the gastric body. This rare case of coexistent multiple malignant lymphomas and early carcinoma of the stomach is reported and discussed.     

A case of triple malignant tumors consisting of esophagus, stomach and malignant lymphoma with a histopathological feature of collision between gastric cancer and malignant lymphoma--a case report

We report a rare case of a collision between a gastric cancer and a malignant lymphoma with a wide systemic metastasis, combined with esophagus cancer, stomach cancer and malignant lymphoma. A 73-year-old man complained of gross hematuria and swelling of the right testis. Magnetic resonance imaging (MRI) revealed that both testes were swollen with unequal contrast and there were numerous tumors in the retroperitoneal space and pelvis. He was diagnosed with malignant diffuse large B cell lymphoma by immunostaining from the extirpated right testis. He received six cycles of R-CHOP therapy. After the second cycle, partial remission was recognized, but the tumors spread again by the fourth cycle. Thereafter, we performed MTX-HOPE therapy as a salvage therapy for four cycles. During this chemotherapy, he felt epigastralgia; esophagus cancer (squamous cell carcinoma) and stomach cancer (highly-differentiated adenocarcinoma) were found by upper endoscopy. However, the gastrointestinal cancer was inoperable, since the malignant lymphoma was progressive. His general status had been exacerbated, and he died about one year after he was diagnosed with malignant lymphoma. Pathological examination revealed that the adenocarcinoma had partly collided with the malignant lymphoma.     

Bilateral synchronous spindle cell, apocrine and scirrhous carcinoma breast cancer in a case or malignant lymphoma

An unusual case of synchronous bilateral breast cancer occurring during combination chemotherapy and radiation to the outside of the breast for malignant lymphoma is reported. Two histologically rare carcinomas, spindle cell carcinoma and apocrine carcinoma, were observed in this case. A 77-year-old woman, who had been treated for stage IIIA non-Hodgkin's lymphoma, developed bilateral breast tumors. Aspiration biopsy cytology findings of the tumor in the left breast showed several clusters of adenocarcinoma cells and some large atypical spindle shaped cells, which suggested spindle cell carcinoma. The cytologic findings of the right breast tumor were highly suggestive of scirrhous carcinoma. A modified radical mastectomy was performed on both breasts. Pathological examination disclosed two separate cancer lesions in the left breast. The lesion which had been detected before the operation, was a spindle cell carcinoma. Another lesion, detected for the first time by pathological examination, was an apocrine carcinoma. The lesion in the right breast was a scirrhous carcinoma. Since non-invasive foci were detected in these three cancer lesions, each lesion was thought to be a primary cancer. All dissected bilateral axillary lymph nodes showed malignant lymphoma. Immuno-histochemistry of the spindle cell carcinoma revealed positive immunoreactivity for cytokeratin, which suggested the epithelial as well as mesenchymal nature of this tumor. Synchronous existence of malignant lymphoma and three independent breast cancers including spindle cell carcinoma and apocrine carcinoma is very rare.     

A case of effective response to TS-1 of inoperable gastric cancer, in the course of chemotherapy for malignant lymphoma

We encountered a case of effective response to TS-1 of inoperable gastric cancer, in the course of chemotherapy for malignant lymphoma. A 78-year-old man, in the course of chemotherapy for malignant lymphoma, complained of appetite loss. A biopsy from gastric endoscopy indicated gastric carcinoma. This was diagnosed as inoperable gastric cancer, and gastro-jejunostomy was performed. After administration of TS-1 orally for 4 courses, it was observed to be effective with no severe adverse events.     

Peritoneal disseminated recurrence after total gastrectomy for perforated gastric malignant lymphoma--a case report

We reported a case of peritoneal disseminated recurrence after total gastrectomy for perforated gastric malignant lymphoma. A 73-year-old man underwent total gastrectomy for perforated gastric diffuse large B cell lymphoma on day 5 of RCHOP (rituximab, cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisolone) chemotherapy. He has rejected chemotherapy and received no additional treatment after gastrectomy. Computer tomography 13 months after surgery revealed peritoneal dissemination and abdominal lymph node metastasis. R-CHOP chemotherapy was performed, and after 4 courses of chemotherapy, peritoneal dissemination and metastatic abdominal lymph nodes disappeared. Chemotherapy was discontinued for a time, however, the tumors relapsed 2 months after stopping chemotherapy. He underwent chemotherapy with etoposide, but died of tumor progression 21 months after gastrectomy.     

Metachronous triple malignant lymphoma of the stomach

A 72-year-old female who had undergone partial gastrectomy (Billroth I method) 8 years earlier because of a diagnosis of malignant carcinoma of the stomach (histopathological diagnosis: ML. Histiocytic, Diffuse--Rappaport--) visited our hospital because of dysphagia for the past three months. X-ray and fiberscopic examination revealed the same malignancy in the remnant stomach. Curative extirpation of the remnant stomach, resection of the lower esophagus and pancreatosplenectomy were performed. There were two lesions in the resected specimen. One was a large tumor of Borrmann 3 type (8 cm in diameter) at the EGJ; the other was a small IIc-like tumor (2 cm in diameter) at the surgical stump on the lessercurvature. These three metachronous malignant lymphomas returned the same pathological findings. Compared to carcinoma, malignant lymphoma of the stomach occurs more frequently in the fornix and the tendency for multiple occurrence is strong. When partial gastrectomy is performed for malignant lymphoma of the stomach, follow-up of the remnant stomach must be carried out carefully.     

A case of bilateral metastatic breast carcinoma from gastric carcinoma

The patient was a 48-year-old woman who had undergone radical surgery for gastric carcinoma in 1981. Seventeen months after the operation, recurrence of gastric carcinoma at the anastomotic stoma was found, and total gastrectomy was performed. Fourteen months after the second operation, she was revealed to have bilateral breast tumors and underwent exploratory excision. Histological examination suggested primary malignant tumor of the breast. Bilateral standard radical mastectomy was done seven days after the excision. Final histological examination revealed metastatic breast cancer originating from the stomach. She died from general metastasis seven months after the radical mastectomy in spite of adjuvant immunochemotherapy.     

Correlational study of vascular endothelial growth factor expression and microvessel density in primary malignant gastric lymphoma

Vascular endothelial growth factor (VEGF) expression and microvessel density (MVD) in primary malignant gastric lymphoma were studied, and their correlation as well as its clinical significance was analyzed. Thirty-five patients diagnosed with primary malignant gastric lymphoma were enrolled in this study. VEGF expression in the tumor tissues was detected by immunohistochemistry. Microvessel density in tumors was counted with Weidner's method and compared with MVD in normal tissues 5 cm away from tumor site. Collected data were analyzed statistically. Our results showed that VEGF expression and MVD in tumor tissues were higher than those in normal tissues, and the difference between these two groups was significant (P < 0.01). As VEGF expression was elevated, MVD was also increased in tumor tissues. Statistical analysis revealed that VEGF expression was positively correlated with MVD (r = 0.392, P < 0.05). VEGF was highly expressed in primary malignant gastric lymphoma and positively correlated with MVD. These results strongly suggest that anti-angiogenesis therapy investigated in gastric lymphoma is a prospective clinical trial.     

Metastatic signet ring cell carcinoma to the breast from stomach]

Metastatic tumors in the breast are quite rare and constitute 0.5 to 6% of all breast malignancies. They often occur in a polymetastatic context. The most frequent primitive tumors are lymphoma, leukaemia and malignant melanoma. The gastric origin is seldom reported. We report here the observation of a 40-years woman operated in urgency for an acute abdominal syndrome. A gastric tumor was discovered intraoperatively with ovarian metastasis and peritoneal carcinosis. The pathological examination revealed a gastric signet ring cell carcinoma with an infiltration of the right ovary. Four months later, the patient presented with a lump of the right breast. The histologic examination corresponded to a mammary metastasis by a signet ring cell carcinoma from stomach. The objective of our work is to discuss through this observation the anatomoclinical and evolutionary characteristics of breast metastasis.     

A case of advanced gastric cancer resistant to S-1 successfully treated with weekly administration of paclitaxel

A 62-year-old female was diagnosed with type 2 advanced gastric cancer in May 2003. Pathological examination showed a poorly differentiated carcinoma. Computed tomography (CT) revealed paraaortic lymph node metastasis, duodenal metastasis and ascites due to peritoneal dissemination. Chemotherapy with CDDP+S-1 was started and continued. After the chemotherapy, there were progressive diseases. Therefore, paclitaxel (PTX) was administered at a dose of 80 mg/m2/day for 3 weeks followed by a week rest. Clinical symptoms were relieved, and CT scan revealed metastatic lymph nodes were reduced after 4 cycles. After 13 cycles, MRI revealed a solitary brain mass was detected. She was resected for a right temporal-occipital brain metastatic tumor, and local cerebral irradiation was performed. After this operation, she was diagnosed with brain metastasis from advanced gastric cancer. The procedure was interrupted for about 6 months. After rehabilitation, PTX treatment was restarted as 14th cycle. She has survived without recurrence more than 30 cycles after the resection. A weekly administration of PTX may be a promising regimen as second-line chemotherapy for S-1 resistant recurrent gastric cancer.     

Diffuse large B-cell lymphoma in the thyroid gland associated with primary hyperparathyroidism

We report a case of primary hyperparathyroidism associated with a malignant lymphoma in the thyroid gland. A 68-year-old woman was admitted to hospital with a cervical mass. Ultrasound and computed tomography (CT) revealed a hypoechoic, multinodular tumor in the left thyroid gland. A gallium-67 citrate scintigram revealed intense radioisotope uptake in the thyroid tumor. Histological examination of biopsy specimens indicated that this tumor was a large B-cell lymphoma. The coexistence of parathyroid adenoma in this patient was revealed by a sestamibi scintigram, performed prior to chemotherapy. Following the complete remission of the lymphoma by chemotherapy, we carried out an excision of the single parathyroid adenoma. To our knowledge, this is the first report to describe a malignant thyroid lymphoma associated with primary hyperparathyroidism.     

A case of coexistent adenocarcinoma and primary malignant lymphoma of the stomach

A case of a simultaneous adenocarcinoma and a primary malignant lymphoma of the stomach is presented. A sixty-one-year-old male was referred to us with epigastralgia. Gastroscopy and a biopsy revealed a *** c-like lesion in the stomach and, on histological examination, was determined as being an adenocarcinoma. A proximal gastrectomy and an R2-resection of lymph nodes then was performed. A pathological examination of the resected stomach disclosed a malignant lymphoma neighboring the adenocarcinoma. The presence of a simultaneous carcinoma and a malignant lymphoma of the stomach is quite rare, with only twenty-eight documented patients reported in the Japanese literature. This entity is discussed.     

Werner's syndrome combined with quintuplicate malignant tumors: a case report and review of literature data

The authors report a case of Werner's syndrome complicated by quintuplicate malignancy, and review the literature data. Four malignancies occurred synchronously in the case: osteosarcoma of the left distal tibia, malignant melanoma of the left plantar region, gastric cancer, pulmonary coin lesion. The osteosarcoma and malignant melanoma were treated by below-knee amputation and the gastric cancer by palliative surgery; the pulmonary coin lesion did not respond to cisplatin chemotherapy. It was difficult to treat the multiple primary cancer curatively, and patient died of respiratory failure due to a brain tumor seven months after surgery. The postmortem examination revealed a papillary carcinoma of the thyroid gland and a leiomyosarcoma of the lung. In some cases of Werner's syndrome, attention should be paid to the concurrent occurrence of multiple primary malignant neoplasms.     

A case of malignant lymphoma, an anemone cell tumor of the leg, arising from osteomyelitis

An 80-year-old man, complaining of multiple fungating growth on his right leg, was hospitalized. A review of his previous history revealed that he had undergone three operations because of repeating osteomyelitis. A clinical examination showed that a tumor was localized on the right leg. Light microscopy revealed that tumor was composed of diffuse large round cell proliferations. Malignant lymphoma was suspected, but was difficult to distinguish in the undifferentiated carcinoma. Electron microscopically, extensive cytoplasmic processes resembling microvilli from the circumferential surface membrane were observed, but desmosomes, tonofilaments, secretory products or basal lamina were not seen. Immunohistochemically, IgG was demonstrated on the tumor cells. These findings led us to diagnoses an anemone cell tumor, originating from a malignant lymphoma and arising from osteomyelitis.     

胃原发性恶性淋巴瘤31例临床分析

目的 探讨胃原发性恶性淋巴瘤临床及内镜表现。方法 回顾性总结本院近十年来31例原发性胃恶性淋巴瘤的临床资料。结果 31例病人临床表现无特异性，上腹痛最常见，其次为上消化道出血等。胃镜表现：病变发生2个以上部位多见，其次为胃体、胃窦等，幽门螺杆菌（Hp）阳性检出率90．3％。结论 胃原发性恶性淋巴瘤临床表现无特异性；其镜下形态多种多样，其中累及2个以上部位者多见，病变范围较大。胃镜活检加免疫组化病理检查是诊断本病的重要手段，Hp感染与胃原发性恶性淋巴瘤的发生具有相关性。     

A case report of primary liver cancer with cerebral metastasis after hepatic resection

A 67-year-old male, who had a left hepatectomy for hepatocellular carcinoma, was readmitted to our hospital because of a left hemiparesis. A brain computed tomography scan and an r-carotid angiogram revealed a large mass involving the right parietal area, and thus a brain tumor removal was performed. A histological diagnosis of the removed brain tumor found it to be a metastatic, hepatocellular carcinoma. The patient died of pulmonary congestion due to lung metastasis, approximately 2 years and seven months after hepatectomy, and 1 year and three months after the removal of this metastatic brain tumor. In selected cases, the removal of a metastatic brain tumor seems to bring about improvements in the quality and duration of life.     

Synchronous adenocarcinoma and mucosa-associated lymphoid tissue (MALT) lymphoma in a single stomach

BACKGROUND: Synchronous gastric adenocarcinoma and primary gastric mucosa-associated lymphoid tissue (MALT) lymphoma are rare, and the characteristics of these tumors are still unclear. METHODS: Histology of endoscopic and surgical specimens of 6012 gastric adenocarcinoma and 25 primary gastric MALT lymphoma cases were reviewed. RESULTS: Five cases of synchronous tumors were found among 25 primary gastric MALT lymphoma patients (20.0%) and among 6012 gastric adenocarcinoma patients (8.3%). Helicobacter pylori was detected only in two cases (40.0%) of these five synchronous cases. In only one case, two types of malignant cells were mingled each other as a colliding tumor. In other four cases, two pathologies coexisted separately. These two types of malignant tumors were not distinguished by endoscopic or gross findings. CONCLUSIONS: Although gastric adenocarcinoma coexists with MALT lymphoma at a relatively high frequency, synchronous carcinoma can be misinterpreted as a multifocal separated lesion of MALT lymphoma owing to their macroscopic resemblance. Therefore, gastric MALT lymphoma patients should be carefully examined by endoscopy, and any suspicious area must be biopsied considering the possibility of coexisting adenocarcinoma. In addition, etiologies other than H. pylori should be considered in these synchronous tumors.     

Three cases of malignant lymphoma of the breast

We report three cases of malignant lymphoma (ML) of the breast and discuss diagnosis and management. The first case is a 35-year-old woman who had a left breast tumor. Fine needle aspiration cytology (FNAC) showed ML. Mastectomy was performed without any adjuvant chemotherapy. Histology revealed diffuse large B-cell lymphoma of REAL classification. Seventy one months after surgery, lesions indicating relapse were detected in nodes of the right axilla, mediastinum and para-aorta.She underwent eight cycles of CHOP regimen, but 1 month after the chemotherapy a brain metastasis was detected. The patient then received a high-dose methotrexate regimen with whole-skull irradiation. The second case is a 47-year-old woman who had anterior neck swelling and bilateral breast tumors. Histology of the tumor revealed diffuse large B-cell lymphoma. The patient underwent eight cycles of CHOP regimen and high-dose chemotherapy (HDC) with peripheral blood stem cell transplantation (PBSCT). Forty eight months after the PBSCT, there is no evidence of disease. The third case is a 38-year-old woman who had a right breast tumor. FNAC of the breast tumor showed ML and a CT scan of the chest revealed lymphadenopathy at the crus of the diaphragm. Histology of the tumor revealed low-grade B-cell lymphoma of MALT type. The patient underwent six cycles of CHOP regimen and HDC supported by PBSCT. Eighteen months after the PBSCT, relapse lesions were detected in nodes of the neck, mediastinum and renal hilum. The patient received nine cycles of a THP-COP regimen.