Asano Naoki, Iijima Katsunori, Terai Shiho, Uno Kaname, Endo Hiroyuki, Koike Tomoyuki, Iwai Wataru, Iwabuchi Toshimitsu, Hatta Waku, Abe Yasuhiko, Imatani Akira, Shimosegawa Tooru
Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Case Rep Gastroenterol. 2011 May;5(2):325-9. doi: 10.1159/000329559. Epub 2011 Jun 7.
Helicobacter pylori infection is the major cause for mucosa-associated lymphoid tissue (MALT) lymphoma and gastric cancers. On the other hand, gastric cancers are known to arise from gastric mucosal atrophy. We here report a case of signet ring cell gastric cancer that developed after radiation therapy for MALT lymphoma in H. pylori-uninfected patient whose stomach did not show gastric mucosal atrophy. A 58-year-old female was referred to our hospital for treatment of gastric MALT lymphoma. This patient was not infected with H. pylori, and upper gastrointestinal endoscopy revealed that she did not have gastric mucosal atrophy but had submucosal tumor-like MALT lymphoma lesion in the anterior wall of the upper gastric body. Since conventional eradication therapy was ineffective, her whole stomach was irradiated as a second-line therapy. The MALT lymphoma lesion turned into complete remission state after the therapy. The patient was followed every 6 months by upper gastrointestinal endoscopy for 4 years as complete remission until a newly developed decolorized depressed lesion was detected in the greater curvature of the proximal antrum, a completely different location from the MALT lymphoma lesion. A biopsy specimen from the lesion contained signet ring cell carcinoma, and she was successfully treated by endoscopic submucosal dissection. No signs of recurrence have been detected so far. The radiation therapy for MALT lymphoma might be associated with the occurrence of this signet ring cell gastric cancer, and since MALT lymphoma is indolent in nature, this case suggests that careful consideration is required when choosing the second-line therapy for MALT lymphoma patients.
幽门螺杆菌感染是黏膜相关淋巴组织（MALT）淋巴瘤和胃癌的主要病因。另一方面，已知胃癌起源于胃黏膜萎缩。我们在此报告一例印戒细胞胃癌病例，该病例发生在一名未感染幽门螺杆菌且胃黏膜无萎缩的患者接受MALT淋巴瘤放射治疗之后。一名58岁女性因胃MALT淋巴瘤被转诊至我院。该患者未感染幽门螺杆菌，上消化道内镜检查显示她没有胃黏膜萎缩，但在胃体上部前壁有黏膜下肿瘤样MALT淋巴瘤病变。由于传统根除治疗无效，作为二线治疗对其全胃进行了放射治疗。治疗后MALT淋巴瘤病变转为完全缓解状态。患者在完全缓解状态下每6个月接受一次上消化道内镜检查，持续4年，直到在胃窦近端大弯处发现一个新出现的脱色凹陷病变，该病变位置与MALT淋巴瘤病变完全不同。病变的活检标本含有印戒细胞癌，她通过内镜黏膜下剥离术成功治愈。目前尚未检测到复发迹象。MALT淋巴瘤的放射治疗可能与该印戒细胞胃癌的发生有关，并且由于MALT淋巴瘤本质上是惰性的，该病例表明在为MALT淋巴瘤患者选择二线治疗时需要仔细考虑。
