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.     

Malignant lymphoma occurring in the residual stomach following gastrectomy: plus discussion based on the literature in Japan

Malignant lymphoma of the remnant stomach was diagnosed in a 53-year-old man 8 years after gastrectomy for a perforated gastric ulcer. Endoscopic examination demonstrated protruding lesions spreading over the entire residual stomach, and biopsy revealed malignant lymphoma. Rectal cancer was diagnosed simultaneously. The residual stomach was completely excised, with splenectomy, in parallel with low anterior resection of the rectum. Histological studies revealed that the lesion in the residual stomach was a lymphoma of the diffuse, large-cell type, according to the Lymphoma–Leukemia Study Group (LSG) classification, with positivity for CD20 and CD45RA, leading to a diagnosis of B-cell lymphoma. Helicobacter pylori microorganisms were found on the luminal surface of the tumor. Despite postoperative chemotherapy, the patient died of disseminated lymphoma 34 months later. Although malignant lymphoma occurring in the residual stomach following gastrectomy is rare, particular attention should be given to the possible presence of a malignant tumor when examining the residual stomach following gastrectomy. Received: April 3, 2002 / Accepted: November 28, 2002 Offprint requests to: H. Oshita     

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 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.     

A case of malignant lymphoma of the remnant stomach

A 46-year-old woman was transferred to our facility with the complaint of epigastric discomfort of more than four months duration. She had undergone partial gastrectomy with Billroth I anastomosis 19 years prior to the admission. An upper GI series revealed multiple, variously sized elevated lesions scattered over the remnant stomach. Fiberscopic examination showed the gastric mucosa replaced by several elevated lesions and giant fold embellished by erosion, injection, and necrotic debris. Pathological examination revealed malignant lymphoma of the large cell type whose main growth was in the mucosa and submucosa. This case was significant in that malignant lymphoma occurred in the remnant stomach and that the tumor converted M-protein in the serum, which was confirmed as IgM-k in the cytoplasma immunohistochemically.     

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 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.     

Effective treatment of simultaneous small cell lung cancer and B-cell lymphoma

Malignant lymphomas have been reported previously to coincide with adenocarcinomas of the stomach and, rarely, the kidney, breast, colon, liver, or lung. Here, we describe the first case to our knowledge of a malignant lymphoma and an extensive disease small cell cancer of the lung. A 60-year-old male was admitted for severe back pain and was found to have multiple enlarged lymph nodes, hepatosplenomegaly, and bilateral pleural effusions. A B-cell non-Hodgkin's lymphoma (NHL) was diagnosed from biopsies of the stomach and liver. Further staging revealed a dense infiltration of the bone marrow by both a small cell lung cancer and a malignant lymphoma. Both tumors responded well to chemotherapy. This unique case report demonstrates that the simultaneous occurrence of small cell lung cancers and malignant lymphomas is extremely rare and may effectively be treated with chemotherapy.     

Spinal Manifestation of Malignant Primary (PLB) and Secondary Bone Lymphoma (SLB)

Manifestation of malignant lymphoma in the spine is rare; there have only been a few cases reported in the literature. Due to its rarity, there is no gold standard for the management of patients suffering from spinal lymphoma manifestations. Methods: We retrospectively reviewed the data for 37 patients (14 female, 23 male) with malignant lymphoma in the spine receiving intervention in our center from March 2006 until June 2020. Neurological impairment, pain, diagnostics, and/or surgical instability were the criteria for surgery in this patient cohort. Otherwise, only CT-guided biopsies were conducted. Analysis of the patient cohort was based on the Karnofsky performance status scale (KPSS), location of the lesion, spinal levels involved, spinal instability neoplastic score (SINS), surgical treatment, histopathological workup, adjuvant therapy, and overall survival. The following surgical procedures were performed: posterior stabilization and decompression in nine patients; decompression and/or tumor debulking in 18 patients; a two-staged procedure with dorsal stabilization and vertebral body replacement in four patients; decompression and biopsy in one patient; a two-stage procedure with kyphoplasty and posterior stabilization for one patient; posterior stabilization without decompression for one patient; a vertebroplasty and cement-augmented posterior stabilization for one patient; and a CT-guided biopsy alone for two patients. Twenty-one patients (56.78%) had ≥1 lesion in the thoracic spine, 10 patients (27.03%) had lesions in the lumbar spine, two patients had lesions in the cervicothoracic junction, two patients had lesions in the thoracolumbar junction, one patient had a lesion in the lumbosacral junction, and one patient had a lesion in the sacrum. The diagnoses of the histopathological workup were diffuse large B-cell lymphoma in 23 (62.16%) cases, indolent lymphoma in 11 (29.74%) cases, anaplastic T-cell lymphoma in one case (2.70%), T-cell lymphoma in one case (2.70%), and Burkitt lymphoma in one (2.70%) case. The median overall survival was 7.2 months (range 0.1–266.7 months). Pre- and postoperative KPSS scores were 70% (IQR 60–80%). Manifestation of malignant lymphomas in the spine is rare. Similar to the approach taken for spine metastases, a surgical intervention in cases of neurological impairment or manifest or potential instability is indicated, followed by chemoimmunotherapy and radiotherapy.     

超声引导下深部淋巴结活检对恶性淋巴瘤诊断的临床分析

目的:探讨超声引导下深部淋巴结活检穿刺小标本对恶性淋巴瘤诊断的临床价值。方法:采用超声引导下淋巴结穿刺活检,经石蜡包埋,HE染色及免疫组化标记的方法进行病理诊断与以往手术切除活检的标本进行比较。结果:31例住院治疗的深部淋巴结肿大患者,超声引导下穿刺标本,并对不同部位、类型的恶性淋巴瘤进行病理诊断及亚型分型,与以往手术切除淋巴结活检相比具有阳性率相同,创伤小,价格低廉,简便易行的特点。结论:超声定位下的淋巴结穿刺活检可以代替淋巴结切除活检,对于仅有深部淋巴结肿大的患者可作为诊断恶性淋巴瘤的方法。     

A case of burkitt’s lymphoma involving both breasts

Primary malignant lymphoma of the breast is rare, and Burkitt's lymphoma is especially rare. We report the case of a 44-year-old woman in whom Burkitt's lymphoma involving both breasts was diagnosed. The patient was referred to our hospital because of a diffuse, firm swelling, like a bulky ball, in both breasts. Fine-needle aspiration cytology (FNAC) of both breast masses revealed malignant lymphoma(ML), and diffuse large B-cell lymphoma was diagnosed based on the results of immunohistochemical studies of a core needle biopsy specimen. The gallium scan revealed very hot lesions in both breasts, but there was no evidence of disseminated disease. We instituted initial therapy, with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) plus intrathecal chemotherapy without performing a chromosome analysis, because the clinical course was very aggressive. A CR was achieved, but after eight cycles of CHOP therapy, the ML relapsed. We then resected the mass in the left breast, and when examination of the surgical specimen revealed relapse of ML and t (8;11) (q24;q32) translocation, Burkitt's lymphoma was diagnosed. High-dose chemotherapy followed by peripheral-blood stem cell transplantation was performed, but the patient died 10 months after her initial presentation at our hospital.     

An extraordinary case in whom gastrointestinal stromal tumor and low-grade malignant lymphoma are seen together in the stomach

Introduction Gastrointestinal system (GIS) is the most common site of involvement of all primary extranodal lymphomas. Gastric lymphoma constitutes 3–6% of all primary stomach malignancies. Stomach is also the commonest site of involvement of gastrointestinal stromal tumors (GIST). We would like to report these rare synchronous tumors in the same patient. Case A 68-year-old male was admitted to the internal medicine clinics with the complaints of abdominal distension. Physical examination was normal. On abdominal computed tomography a 12 × 14 × 22 cm sized giant tumoral mass was detected in left hypochondrium. A total gastrectomy was performed. Two distinct neoplasms were detected; one of which was located in the posterior wall of the stomach with the size of 24 × 16 × 13 cm, and the other one was localized in the fundus of the stomach and its size was 6 × 5 × 2 cm. Pathological evaluation revealed the diagnosis of GIST at the posterior wall and low-grade malignant lymphoma from the mass localized in the fundus of the stomach. Discussion Two primary tumors are not seen so often together in the stomach. Adenocarcinoma and associated tumors including gastric lymphoma (especially MALT lymphoma), carcinoid, leiomyosarcoma and rhabdomyosarcoma constitute most of the reported series. Rarely adenocarcinoma and associated GIST cases were reported. It is important to report concurrent gastric lymphoma and GIST case since it is extremely rare in the English literature.     

A Case of Concomitant Association of Early Esophageal Carcinoma, Early Gastric Carcinoma and Malignant Lymphoma of the Stomach

A case of concomitant association of early esophageal carcinoma,cancer of the early gastric carcinoma and malignant lymphomaof the stomach was reported. The intrathoracic esophagus wasresected with the whole stomach, and the esophagus was reconstructedwith the right side colon. There were two separate early carcinomasin the upper and lower esophagus. The upper lesion was intraepithelialsquamous cell carcinoma, and the extension of lower lesion alsolimited in the intraepithelial layer. He had also signet ringcell carcinoma of the stomach which was limited only in themucosal layer. In addition, there was malignant lymphoma invadedinto the mucosa and sub-mucosa at the antral rigion of the stomach.There was no lymph node metastasis. The patient is living wellnow. The association of early esophageal carcinoma with earlystomach carcinoma is rare. Only five such cases have been reportedin the Japanese literature.     

A case of metastatic malignant melanoma of the stomach treated by a surgical operation

A metastatic malignant melanoma of the stomach is not a disease of rate occurrence, but reports of melanomas that were clinically diagnosed and were treated by a surgical operation are rare. The case presented is a 73-year-old woman, who underwent an excision of a malignant melanoma of the left sole in 1981. Subsequently, she had a subcutaneous metastasis of a melanoma three times and was treated by a resection and immunochemotherapy. In January, 1988, an X-ray examination of stomach revealed a giant elevated lesion, and an endoscopic examination of the stomach revealed a black pigmented tumor with ulceration. A biopsy taken from the tumor confirmed the diagnosis of a malignant melanoma. Thus, she was given a total gastrectomy. Reports in the Japanese literature of metastatic malignant melanomas of the stomach diagnosed while the patient was still living amount to 11 cases. Of this number, 3 patients were given a surgical operation. Further, these 3 patients lived longer than the non-surgically treated cases and had a better quality of remaining life.     

A primary malignant lymphoma of the appendix

A malignant lymphoma (ML) of the gastrointestinal tract occurs most frequently in the stomach, and ML of the appendix is very rare, with only 16 cases reported in the Japanese literature. Reported is a case of a primary ML the appendix in a 48 year old male, in whom an ileocecal resection was carried out. This case was pathohistologically diagnosed as a diffuse large lymphoma of the B cell type, according to the LSG classification. Therapeutic problems were encountered because of the difficulty in making an early diagnosis.     

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。     

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 coexisting primary malignant lymphoma and adenocarcinoma of the stomach

Reports of the presence of two histologically different neoplasms in one organ are still unusual. We experienced a rare case of coexisting primary malignant lymphoma and adenocarcinoma of the stomach. A 66-year-old woman was admitted in April 1983 because of weight loss and epigastralgia. Several examinations including gallium scan, upper GI endoscopy, biopsy and touch cytology of the stomach, were performed, and she was diagnosed as having primary malignant lymphoma (noncleaved, large cell type) of the stomach. After the administration of 20 mg of vincristine, 6,000 mg of cyclophosphamide, 1,000 mg of prednisolone and 150 mg of Adriamycin, she improved to complete remission in August 1983. In February 1984, she received gastrectomy because of stenosis of the esophagogastric junction. Microscopic examination of the ulcerated lesion at esophagogastric junction revealed moderately differentiated tubular adenocarcinoma infiltrating to the subserosa. Despite chemotherapy, peritonitis carcinomatosa developed, and the patient died of cachexia in July 1984.     

MR Imaging of the primary breast lymphoma: A case report

Recently magnetic resonance (MR) imaging has been investigated for the detection and differentiation of benign and malignant breast lesions. Dynamic scan using the contrast material has been shown to increase the specificity of breast MR imaging. Primary breast lymphoma (PBL) is a rare disease and its MR imaging finding has not been described before. We recently experienced a case of PBL that was demonstrated on MR imaging as an early enhancing mass similar to common carcinomas. Other imaging findings including sonography, mammography were also non-specific. Furthermore, lymphoma cells had spread beyond the early enhanced area. Thus the precise delineation of the tumor extent was impossible. However, features such as a quite unclear border on pre-contrast T2-weighted image, and increased uptake of gallium-67-citrate may allow diagnosis of such lesions as malignant lymphoma.     

原发性胃恶性淋巴瘤：附六例报告并文献复习

Six cases of primary malignant lymphoma in the stomach are reported with a review of 586 cases reported from 1950 through 1987 in our country. The disease is rare. The first case was reported abroad in 1829 and in our country in 1951. Abdominal pain, anorexia and hemorrhage in the gastrointestinal tract were the main symptoms. Surgery was the treatment of choice. The 5-year survival rate was 57.0% abroad and 44.6 at home. Adjuvant postoperative radiotherapy or chemotherapy can improve the 5-year survival. In the review, 5-year survival rate was increased by 6.8% in the group where surgery was combined with radiotherapy and by 5.7% in the group of operation plus chemotherapy. The increase in 10-year survival rate was more obvious. Of these 6 cases, 3 treated by surgical treatment alone died, while 3 treated by operation and postoperative chemotherapy are still alive and tumor-free.