Xue Li-Jun, Yang Ji-Hong, Su Quan-Sheng, Wang Hai, Liu Chang
Department of Oncology and Hematology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China.
Case Rep Oncol. 2010 Jul 10;3(2):223-230. doi: 10.1159/000317603.
Synchronous double malignancies of gastric carcinoma (GC) and malignant lymphoma (ML) are rare and very difficult to treat. We report a case of synchronous GC and nodal ML, regarding which clinical and pathological features and treatment are discussed. A 68-year-old woman with a history of inguinal hernia was admitted for abdominal pain and high fever and subsequently underwent herniorrhaphy, but the fever remained. Computerized tomography showed a stomach mass and multiple enlarged lymph nodes in the abdominal cavity and inguinal regions. Gastric adenocarcinoma coexistent with advanced in situ follicular lymphoma was confirmed by endoscopy, biopsy of inguinal lymph nodes and bone marrow examination. Two chemotherapy regimens, R-CHOP (rituximab, cyclophosphamide, perarubicin, vincristine and prednisone) and systemic therapy (5-fluorouracil and calcium folinate) combined with regional perfusion (oxaliplatin and etoposide) through the left gastric artery were performed at intervals against ML and GC, respectively. Partial remission in both tumors was achieved after 4 courses of treatment, but the patient finally died of heart failure. Scrupulous biopsy of non-draining lymph nodes in patients with gastrointestinal carcinomas is supposed to improve the diagnostic rate of simultaneous nodal ML. The interval chemotherapy strategy with two independent regimens is beneficial for such patients, especially for those unable to tolerate major surgery.
胃癌（GC）与恶性淋巴瘤（ML）同时发生的双重恶性肿瘤较为罕见且治疗难度极大。我们报告一例GC与淋巴结ML同时发生的病例，并对其临床和病理特征及治疗情况进行讨论。一名有腹股沟疝病史的68岁女性因腹痛和高热入院，随后接受了疝修补术，但仍持续发热。计算机断层扫描显示胃部有肿块，腹腔和腹股沟区有多个肿大淋巴结。通过内镜检查、腹股沟淋巴结活检及骨髓检查确诊为胃腺癌合并晚期原位滤泡性淋巴瘤。分别间隔进行了两种化疗方案，即针对ML的R-CHOP（利妥昔单抗、环磷酰胺、表柔比星、长春新碱和泼尼松）以及针对GC的全身治疗（5-氟尿嘧啶和亚叶酸钙）联合经胃左动脉区域灌注（奥沙利铂和依托泊苷）。经过4个疗程的治疗，两个肿瘤均实现部分缓解，但患者最终死于心力衰竭。对于胃肠道癌患者，仔细对未引流淋巴结进行活检应可提高同时发生的淋巴结ML的诊断率。采用两种独立方案的间隔化疗策略对此类患者有益，尤其是对于那些无法耐受大手术的患者。
