Department of Gastroenterological Surgery, Kindai University Nara Hospital, 1248-1, Otoda-cho, Ikoma, Nara, 630-0293, Japan.
Department of Pathology, Kindai University Nara Hospital, Nara, Japan.
Clin J Gastroenterol. 2021 Oct;14(5):1350-1357. doi: 10.1007/s12328-021-01482-8. Epub 2021 Jul 20.
This report presents an extremely rare case of synchronous gastric cancer and primary adrenal diffuse large B-cell lymphoma (DLBCL). An 82-year-old man underwent computed tomography, which revealed a heterogeneous appearing and hypodense adrenal mass and a gastric mass with no enlarged lymph nodes in the neck, mediastinum, abdomen, and inguinal region. Upper gastrointestinal endoscopy revealed a protruding gastric tumor. The specimens obtained from endoscopic biopsy were histologically confirmed to be adenocarcinoma. The hormonal findings eliminated functional adrenal tumor. The patient underwent distal gastrectomy with regional lymph node resection for gastric cancer and incisional biopsy of the adrenal mass. Based on the pathological findings, diagnoses of mixed mucinous and tubular adenocarcinomas of the stomach and adrenal DLBCL were confirmed. Postoperation, the patient received rituximab combined with low-dose doxorubicin, cyclophosphamide, vincristine, and prednisone (R-miniCHOP). Six courses of R-miniCHOP were planned, but were completed in only one course at the patient's request. The patient died 2 months after surgery.
本报告介绍了一例极为罕见的胃弥漫大 B 细胞淋巴瘤(DLBCL)与原发性肾上腺弥漫大 B 细胞淋巴瘤同时发生的病例。一名 82 岁男性接受了计算机断层扫描,结果显示肾上腺有一个不均匀的、低密的肿块,颈部、纵隔、腹部和腹股沟区域无肿大的淋巴结,胃内有一个肿块。上消化道内镜检查发现一个突出的胃肿瘤。内镜活检获得的标本经组织学证实为腺癌。激素检查排除了功能性肾上腺肿瘤。患者因胃癌行胃远端切除术和区域淋巴结清扫术,并对肾上腺肿块进行了切开活检。根据病理结果,确诊为胃混合黏液性和管状腺癌及肾上腺弥漫大 B 细胞淋巴瘤。术后,患者接受了利妥昔单抗联合低剂量阿霉素、环磷酰胺、长春新碱和泼尼松(R-miniCHOP)治疗。计划进行 6 个疗程的 R-miniCHOP,但由于患者要求,仅完成了 1 个疗程。患者在手术后 2 个月死亡。