Yachida Shinichi, Sasako Mitsuru, Tobinai Kensei, Matsuno Yoshihiro, Shimoda Tadakazu
Gastric Surgery Division, National Cancer Center Hospital, Tokyo, Japan.
Hepatogastroenterology. 2010 Mar-Apr;57(98):383-7.
Primary gastric lymphomas generally are of B-cell lineage. Among the previously reported cases of exceptional primary gastric T-cell lymphomas, most demonstrate evidence of human T-cell leukemia virus type 1 (HTLV-1) infection with a poor prognosis. The present study is a report of a rare case of primary gastric T-cell lymphoma without HTLV-1 which could be successfully treated with surgical resection and adjuvant chemotherapy. The patient was a 50-year-old Japanese male who presented with epigastric pain. Clinical examination showed no lymphadenopathy or skin changes. Radiographic and endoscopic examinations revealed an ill-demarcated ulcerative lesion in the stomach, and a biopsy specimen confirmed high-grade lymphoma. Total gastrectomy with regional lymph node dissection was performed. Histological examination of the gastric lesion revealed a malignant lymphoma, diffuse large cell type, with lymph nodal involvement. On immunohistochemistry, tumor cells were positive for CD3, CD4 and CD30, but negative for CD8, CD20 and CD56, implying a T-cell nature. Following surgery, the patient received 8 cycles of chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisolone/CHOP). To date the patient has been free of recurrence for 86 months without further treatment. Review of previously reported cases of primary gastric T-cell lymphoma indicates that the prognosis is better without than with HTLV-1. We conclude that primary gastric T-cell lymphomas without HTLV-1 should be managed in the same way as the more common diffuse large B-cell type gastric lymphomas.
原发性胃淋巴瘤通常起源于B细胞系。在先前报道的罕见原发性胃T细胞淋巴瘤病例中，大多数显示出1型人类T细胞白血病病毒（HTLV-1）感染的证据，预后较差。本研究报告了一例罕见的无HTLV-1感染的原发性胃T细胞淋巴瘤病例，该病例通过手术切除和辅助化疗得以成功治疗。患者为一名50岁的日本男性，表现为上腹部疼痛。临床检查未发现淋巴结肿大或皮肤改变。影像学和内镜检查显示胃内有边界不清的溃疡性病变，活检标本证实为高级别淋巴瘤。遂行全胃切除术及区域淋巴结清扫术。胃病变的组织学检查显示为恶性淋巴瘤，弥漫大细胞型，伴有淋巴结受累。免疫组化检查显示，肿瘤细胞CD3、CD4和CD30呈阳性，但CD8、CD20和CD56呈阴性，提示为T细胞性质。手术后，患者接受了8个周期的化疗（环磷酰胺、阿霉素、长春新碱和泼尼松/CHOP方案）。迄今为止，患者未经进一步治疗已无复发86个月。回顾先前报道的原发性胃T细胞淋巴瘤病例表明，无HTLV-1感染的患者预后比有该病毒感染的患者更好。我们得出结论，无HTLV-1感染的原发性胃T细胞淋巴瘤应与更常见的弥漫大B细胞型胃淋巴瘤采用相同的治疗方法。
