Korean J Gastroenterol.  2015 Jan;65(1):43-47. 10.4166/kjg.2015.65.1.43.

Gastric Perforation Caused by Primary Gastric Diffuse Large B Cell Lymphoma

• Kim JS
• Rou WS
• Ahn BM
• Moon HS
• Kang SH
• Sung JK
• Jeong HY
• Song KS

• KMID: 2373179
• DOI: http://doi.org/10.4166/kjg.2015.65.1.43

Abstract

Spontaneous gastric perforation is a rare complication of gastric lymphoma that is potentially life threatening since it can progress to sepsis and multi-organ failure. Morbidity also increases due to prolonged hospitalization and delay in initiating chemotherapy. Therefore prompt diagnosis and appropriate treatment is critical to improve prognosis. A 64-year-old man presented to the emergency department with severe abdominal pain. Chest X-ray showed free air below the right diaphragm. Abdominal CT scan also demonstrated free air in the peritoneal cavity with large wall defect in the lesser curvature of gastric lower body. Therefore, the patient underwent emergency operation and primary closure was done. Pathologic specimen obtained during surgery was compatible to diffuse large B cell lymphoma. Fifteen days after primary closure, the patient received subtotal gastrectomy and chemotherapy was initiated after recovery. Patient is currently being followed-up at outpatient department without any particular complications. Herein, we report a rare case of gastric lymphoma that initially presented as peritonitis because of spontaneous gastric perforation.

Keyword

Gastric lymphoma; Perforation

MeSH Terms

Abdominal Pain
Antigens, CD20/metabolism
Antigens, CD45/metabolism
Antineoplastic Combined Chemotherapy Protocols/therapeutic use
Gastrectomy
Humans
Intestinal Perforation/diagnostic imaging
Lymphoma, Large B-Cell, Diffuse/*diagnosis/drug therapy/pathology
Lymphoma, Non-Hodgkin/*diagnosis/drug therapy/pathology
Male
Middle Aged
Positron-Emission Tomography
Stomach Neoplasms/*diagnosis/drug therapy/pathology
Tomography, X-Ray Computed
Antigens, CD20
Antigens, CD45

Figure

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  Fig. 1. Chest X-ray findings. Free air is seen below the right diaphragm.

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  Fig. 2. Abdominal CT scan findings. A large wall defect (arrows) and edema-tous thickening are noted in the lesser curvature of gastric lower body (A, transverse view; B, coronal view).

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  Fig. 3. Microscopic findings. Diffuse proliferation of medium to large sized lymphocytes having vesicular nuclei with smooth chromatin and scant cytoplasm are observed (H&E; A, ×100; B, ×400). Immunohistochemistry staining shows that the tumor cells are positive for CD 20 (C, ×100) and leukocyte common antigen (D, ×100).

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  Fig. 4. Endoscopic and gross findings.(A) An ulcerative lesion extending from the lesser curvature of gastric lower body to the gastric angle can be seen.(B) Suture line is observed on the anterior side of the lesion. (C, D) The resected specimen demonstrates a ulceroinfiltrative lesion containing 3.0×1.8 cm sized tumor in the lesser curvature of lower body.

Reference

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