Yamada Masanori, Nakai Koji, Inoue Kentaro, Hijikawa Takeshi, Kitade Hiroaki, Ishii Kazuyoshi, Yoshioka Kazuhiko, Kon Masanori
Dept. of Surgery, Kansai Medical University.
Gan To Kagaku Ryoho. 2016 Nov;43(12):2395-2397.
A 54-year-old man presented with cervical lymph node swelling and exhibited high levels of sIL-2R. Enhanced cervical, chest, and abdominal CT scanning demonstrated swelling of the cervical, hilar, axilla, and abdominal lymph nodes. The patient was diagnosed with malignant, non-Hodgkin's lymphoma, B-cell, follicular lymphoma using biopsy of the cervical lymph nodes. Gastrointestinal endoscopy revealed II c like advanced tumor in the upper gastric body and post-wall area. He was diagnosed with primary multiple cancer comprising malignant lymphoma and gastric cancer. It was difficult to elevate the jejunum for esophagojejunal anastomosis due to the giant abdominal lymph node swelling. The patient received 5 courses of combination R-CHOP chemotherapy for malignant lymphoma. The swollen lymph nodes considerably reduced in size after chemotherapy. Totalgastrectomy with reconstruction using the Roux-en-Y method was performed for gastric cancer. Histopathological findings revealed pT3(SS), pN0, pH0, pP0, pStage I B. The patient achieved complete remission following another course of chemotherapy and involved field radiation therapy. At present, he shows no signs of recurrence of primary multiple cancer.
一名54岁男性因颈部淋巴结肿大就诊，其可溶性白细胞介素-2受体（sIL-2R）水平升高。颈部、胸部和腹部增强CT扫描显示颈部、肺门、腋窝和腹部淋巴结肿大。通过颈部淋巴结活检，该患者被诊断为恶性非霍奇金淋巴瘤，B细胞滤泡性淋巴瘤。胃肠内镜检查发现胃体上部和后壁区域有II c型进展期肿瘤。他被诊断为原发性多发性癌，包括恶性淋巴瘤和胃癌。由于巨大的腹部淋巴结肿大，难以将空肠提起进行食管空肠吻合术。该患者接受了5个疗程的恶性淋巴瘤联合R-CHOP化疗。化疗后肿大的淋巴结体积明显缩小。对胃癌患者进行了Roux-en-Y法重建的全胃切除术。组织病理学检查结果显示为pT3(SS)、pN0、pH0、pP0、p分期I B。在接受另一疗程的化疗和累及野放射治疗后，患者实现了完全缓解。目前，他没有原发性多发性癌复发的迹象。
