Fujita Ryo, Ono Hidetaka A, Tsuura Yukio, Yakeishi Mayumi, Kobayashi Kei, Daibo Susumu, Sakai Jun, Suwa Hirokazu, Minami Yuta, Nojiri Kazunori, Yosida Kenichi, Mogaki Masatoshi, Masui Hidenori, Nagahori Kaoru
Dept. of Surgery, Yokosuka Kyosai Hospital.
Gan To Kagaku Ryoho. 2022 Feb;49(2):208-210.
A 75-year-old man was showed wall thickening just below esophagogastric junction(EGJ)by gastroscopy(GS). Biopsy indicated mucinous carcinoma. He was referred to our hospital. Computed tomography(CT), PET-CT showed EGJ cancer and splenic tumor. EGJ cancer was diagnosed GE, Siewert Type Ⅱ, GrePostAnt, Type 1, cT2, cN0, cM0, cStage Ⅰ. The patient underwent total gastrectomy, lower esophagectomy, D2+ #19, 20, 110, 111, 112 lymph nodes dissection, Rou-en- Y reconstruction, distal pancreatectomy, splenectomy, cholecystectomy, and enterostomy. Postoperative complication was pancreatic fistula(Grade Ⅱ). Pathological diagnosis was esophagogastric junction cancer, neuroendocrine carcinoma(NEC), GE, Siewert Type Ⅱ, GrePostAnt, Type 1, pT2(MP), pN1, pM0, pStage ⅡA. Splenic tumor was diagnosed splenic malignant lymphoma, large B-cell, diffuse(DLBCL), NOS, low-immediate risk. Patient was discharged 15 days after the operation and underwent adjuvant chemotherapy with S-1. In this case, he started taking S-1 because the prognosis of NEC is poorer than PSML. There was no evidence of recurrence after 5 months from gastrectomy. As a result of searching for"neuroendocrine tumor"and"malignant lymphoma"in the JAMAS, there was no report of NEC associated with malignant lymphoma. We experienced the rare case of primary splenic malignant lymphoma associated with EGJ NEC. In the case of gastric cancer with splenic tumor, malignant lymphoma of spleen should be concerned.
一名75岁男性经胃镜检查显示食管胃交界（EGJ）下方壁增厚。活检提示黏液癌。他被转诊至我院。计算机断层扫描（CT）、正电子发射断层显像/X线计算机体层成像（PET-CT）显示EGJ癌和脾脏肿瘤。EGJ癌诊断为胃食管交界腺癌，SiewertⅡ型，GrePostAnt，1型，cT2，cN0，cM0，cⅠ期。患者接受了全胃切除术、食管下段切除术、D2+#19、20、110、111、112淋巴结清扫术、Rou-en-Y重建术、胰腺远端切除术、脾切除术、胆囊切除术和肠造口术。术后并发症为Ⅱ级胰瘘。病理诊断为食管胃交界癌，神经内分泌癌（NEC），胃食管交界腺癌，SiewertⅡ型，GrePostAnt，1型，pT2（MP），pN1，pM0，pⅡA期。脾脏肿瘤诊断为脾脏恶性淋巴瘤，大B细胞，弥漫性（弥漫大B细胞淋巴瘤，NOS），低即刻风险。患者术后15天出院，并接受了替吉奥辅助化疗。在本病例中，他开始服用替吉奥是因为NEC的预后比原发性脾脏恶性淋巴瘤（PSML）差。胃切除术后5个月无复发迹象。在《日本医学协会杂志》（JAMAS）中检索“神经内分泌肿瘤”和“恶性淋巴瘤”，未发现NEC与恶性淋巴瘤相关的报道。我们遇到了1例罕见的原发性脾脏恶性淋巴瘤合并EGJ NEC的病例。对于伴有脾脏肿瘤的胃癌，应考虑脾脏恶性淋巴瘤。
