Korean J Gastroenterol.  2012 May;59(5):377-381. 10.4166/kjg.2012.59.5.377.

A Case of Synchronous Early Gastric Cancer and Diffuse Large B Cell Lymphoma Treated with Endoscopic Submucosal Dissection and Chemotherapy

• Park JH
• Jang JY
• Cho YD
• Dong SH
• Kim HJ
• Kim BH
• Chang YW

• KMID: 1792838
• DOI: http://doi.org/10.4166/kjg.2012.59.5.377

Abstract

Among malignant tumors of the stomach, adenocarcinoma takes up about 95% and the remaining are mostly lymphomas, being less than 5%. The majority of lymphomas are B cell lymphomas, and the most common types are low-grade B cell lymphoma of mucosa-associated lymphoid tissue and diffuse large B cell lymphoma (DLBL). The synchronous occurrence of adenocarcinoma and lymphoma in the stomach is being reported rarely. Especially the concurrence of adenocarcinoma and DLBL is very scarce and less than 10 cases have been reported inside and outside this country. In the past, the general treatment for cases of concurrence of adenocarcinoma and DLBL when surgery is possible according to cancer stages was gastrectomy, followed by single or combined chemotherapy and radiation treatment. However, when considering that most cases of concurrent adenocarcinoma were early gastric cancer which is limited to the mucosa, endoscopic submucosal dissection (ESD) can become an alternative treatment method for gastrectomy. We report the experience with chemotherapy and ESD done together instead of surgery, in patients concurrently diagnosed with early gastric cancer and gastric lymphoma.

Keyword

Early gastric cancer; Lymphoma; Endoscopic submucosal dissection; Chemotherapy

MeSH Terms

Adenocarcinoma/*drug therapy/surgery
Anti-Bacterial Agents/therapeutic use
Antineoplastic Agents/therapeutic use
Drug Therapy, Combination
Helicobacter Infections/drug therapy
Humans
Lymphoma, Large B-Cell, Diffuse/*drug therapy/pathology
Male
Middle Aged
Stomach Neoplasms/*drug therapy/surgery

Figure

• 

  Fig. 1 Gastroscopic findings. (A) About 4 cm sized polypoid mass was noted at the fundus. (B) About 2.0 cm sized flat elevated lesion with scar change was noted at the greater curvature side of the lower body.

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  Fig. 2 Microscopic finding of gastric lymphoma. (A) The lesion showed atypical, large lymphoid cells (H&E, ×200). (B) It showed positive staining on lymphoid tissue to brown color for CD20, a B-cell marker (Immunohistochemical stain, ×200).

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  Fig. 3 Specimen of the early gastric cancer after endoscopic submucosal dissection of gastric mucosa. (A) Gross finding of resected lesion by the endoscopic submucosal dissection. (B) The lesion showed well differentiated tubular adenocarcinoma with focal submucosal invasion (H&E, ×100).

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  Fig. 4 Follow-up gastroscopic findings, 3 months after the endoscopic submucosal dissection and chemotherapy. Only scar changes were found at the site of previous diffuse large B cell lymphoma (A) and the early gastric cancer (B).

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