J Gastric Cancer.  2017 Jun;17(2):180-185. 10.5230/jgc.2017.17.e11.

Gastric Adenocarcinoma Secondary to Primary Gastric Diffuse Large B-cell Lymphoma

• Sakr R
• Massoud M
• Aftimos G
• Chahine G

• KMID: 2383741
• DOI: http://doi.org/10.5230/jgc.2017.17.e11

Abstract

Despite the decreasing incidence and mortality from gastric cancer, it remains a major health problem worldwide. Ninety percent of cases are adenocarcinomas. Here, we report a case of gastric adenocarcinoma developed after successful treatment of prior primary gastric diffuse large B-cell lymphoma (DLBCL). Our patient was an elderly man with primary gastric DLBCL in whom complete remission was achieved after R-CHOP (cyclophosphamide, adriamycin, vincristine, prednisolone plus rituximab) chemotherapy. Helicobacter pylori infection persisted despite adequate treatment leading to sustained chronic gastritis. The mean time to diagnose metachronous gastric carcinoma was seven years. We believe that a combination of many risk factors, of which chronic H. pylori infection the most important, led to the development of gastric carcinoma following primary gastric lymphoma. In summary, patients who have been successfully treated for primary gastric lymphoma should be followed up at regular short intervals. H. pylori infection should be diagnosed promptly and treated aggressively.

Keyword

Neoplasms, second primary; Stomach neoplasms; Lymphoma

MeSH Terms

Adenocarcinoma*
Aged
B-Lymphocytes*
Doxorubicin
Drug Therapy
Gastritis
Helicobacter pylori
Humans
Incidence
Lymphoma
Lymphoma, B-Cell*
Mortality
Neoplasms, Second Primary
Prednisolone
Risk Factors
Stomach Neoplasms
Vincristine
Doxorubicin
Prednisolone
Vincristine

Figure

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  Fig. 1 Abdominal computed tomography scan: 3-cm circumferential wall thickening of the entire stomach, mainly at the fundus and antrum, can be seen. Absence of contrast enhancement.

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  Fig. 2 Diffuse interstitial infiltration by large lymphoid cells, CD20+, CD10−, and cyclin D1 (H&E, ×100).

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  Fig. 3 Tumor cells expressing CD20 (immunohistochemistry, ×100).

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  Fig. 4 Computed tomography scan of the abdomen 4 months after completion of chemotherapy showing complete resolution of the previously noted gastric tumor.

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  Fig. 5 Glandular proliferation lined with cylindrical epithelial cells with atypical and hyperchromatic nuclei that are compatible with microfoci of invasive gastric adenocarcinoma of the intestinal type (H&E, ×400).

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