Tagami Keita, Tanda Shigeru, Tokumura Hiromi, Yamaguchi Masaaki
Dept. of Internal Medicine Residents, Tohoku Rosai Hospital.
Gan To Kagaku Ryoho. 2010 Dec;37(13):2891-5.
We report a rare case of a collision between a gastric cancer and a malignant lymphoma with a wide systemic metastasis, combined with esophagus cancer, stomach cancer and malignant lymphoma. A 73-year-old man complained of gross hematuria and swelling of the right testis. Magnetic resonance imaging (MRI) revealed that both testes were swollen with unequal contrast and there were numerous tumors in the retroperitoneal space and pelvis. He was diagnosed with malignant diffuse large B cell lymphoma by immunostaining from the extirpated right testis. He received six cycles of R-CHOP therapy. After the second cycle, partial remission was recognized, but the tumors spread again by the fourth cycle. Thereafter, we performed MTX-HOPE therapy as a salvage therapy for four cycles. During this chemotherapy, he felt epigastralgia; esophagus cancer (squamous cell carcinoma) and stomach cancer (highly-differentiated adenocarcinoma) were found by upper endoscopy. However, the gastrointestinal cancer was inoperable, since the malignant lymphoma was progressive. His general status had been exacerbated, and he died about one year after he was diagnosed with malignant lymphoma. Pathological examination revealed that the adenocarcinoma had partly collided with the malignant lymphoma.
我们报告了一例罕见的胃癌与恶性淋巴瘤碰撞病例，伴有广泛的全身转移，并合并食管癌、胃癌和恶性淋巴瘤。一名73岁男性主诉肉眼血尿和右侧睾丸肿大。磁共振成像（MRI）显示双侧睾丸肿大，强化不均匀，腹膜后间隙和盆腔有大量肿瘤。通过对切除的右侧睾丸进行免疫染色，他被诊断为恶性弥漫性大B细胞淋巴瘤。他接受了六个周期的R-CHOP治疗。第二个周期后，出现部分缓解，但到第四个周期肿瘤再次扩散。此后，我们进行了四个周期的MTX-HOPE治疗作为挽救治疗。在此次化疗期间，他感到上腹部疼痛；上消化道内镜检查发现了食管癌（鳞状细胞癌）和胃癌（高分化腺癌）。然而，由于恶性淋巴瘤进展，胃肠道癌无法手术。他的一般状况恶化，在被诊断为恶性淋巴瘤约一年后死亡。病理检查显示腺癌部分与恶性淋巴瘤碰撞。
