Spaziani Erasmo, Di Filippo Annalisa Romina, Valle Giampaolo, Spaziani Martina, Francioni Piero, Caruso Gianluca, Tamagnini Giovanni Traumueller, Mosciatti Edoardo, Picchio Marcello, De Cesare Alessandro
Ann Ital Chir. 2023 Mar 6;12:S2239253X23039221.
Primary gastric Burkitt lymphoma (PG BL) and malignant pleural mesothelioma (MPM) are rare and aggressive tumors with poor prognosis. HIV and EBV infection have a link in the aetiology of PG BL, while MPM is usually associated with asbestos exposure. Endoluminal bleeding from massive solid tumor, and dyspnea usually due to pleural effusion, are the typical clinical manifestations respectively of PG BL and MPM. In most patients just palliative treatment is indicated.
A caucasian elderly male, negative for the proven risk factors, presenting respiratory failure due to massive left pleural effusion with severe mediastinal shift. Contrast enhanced - Computed Tomography (CE-CT) showed a large mass causing circumferential thickening of the gastric fundus, infiltrating the left diaphragmatic dome and the ipsilateral crus. Macroscopically, on endoscopy the gastric fundus appeared completely occupied by an ulcerated large mass protunding in the gastric lumen. Histopathological examination from biopsy specimens taken during esophagogastroduodenoscopy and thoracoscopy allowed to make diagnosis of PG BL and MPM. The patient first underwent a placement of a chest tube drainage for the pleural effusion and then a thoracoscopic talc insufflation (TTI) in the left hemithorax. A surgical treatment of the gastric lesion was planned, due to the rapid growth and the high risk of bleeding. The patient died because of fatal cardiac arrhythmia, before undergoig abdominal surgery.
This report presents an unique case of PG BL associated with MPM and highlights the real challenge for the physicians to identify them in early stage, especially in patients without the proved risk factors. The onset symptoms make it a very singular case, characterized by severe dyspnea up to respiratory failure, due to massive left pleural effusion and contralateral mediastinal fluttering, without an active bleeding from the gastric mass, while CE-CT findings were instead negative for pleural thickening and positive for circumferential thickening of the gastric fundus.
Burkitt Lymphoma, Case Report, Gastric, Pleural Mesothelioma, Pleural Effusion, Respiratory Failure.
原发性胃伯基特淋巴瘤（PG BL）和恶性胸膜间皮瘤（MPM）是罕见的侵袭性肿瘤，预后较差。HIV和EBV感染与PG BL的病因有关，而MPM通常与接触石棉有关。PG BL和MPM的典型临床表现分别为巨大实体瘤引起的腔内出血和通常由胸腔积液导致的呼吸困难。大多数患者仅需进行姑息治疗。
一名白种老年男性，无已证实的危险因素，因大量左侧胸腔积液伴严重纵隔移位出现呼吸衰竭。对比增强计算机断层扫描（CE-CT）显示一个大肿块，导致胃底周向增厚，浸润左膈穹窿和同侧膈脚。在内镜检查中，肉眼可见胃底完全被一个向胃腔内突出的溃疡性大肿块占据。通过食管胃十二指肠镜检查和胸腔镜检查获取的活检标本进行组织病理学检查，确诊为PG BL和MPM。患者首先接受了胸腔闭式引流以排出胸腔积液，然后在左半胸进行了胸腔镜滑石粉喷洒（TTI）。由于胃部病变生长迅速且出血风险高，计划对其进行手术治疗。患者在接受腹部手术前因致命性心律失常死亡。
本报告呈现了一例PG BL合并MPM的独特病例，并强调了医生在早期识别它们的真正挑战，尤其是在没有已证实危险因素的患者中。该病例的起病症状非常独特，表现为因大量左侧胸腔积液和对侧纵隔扑动导致严重呼吸困难直至呼吸衰竭，而胃部肿块无活动性出血，而CE-CT结果显示胸膜增厚为阴性，胃底周向增厚为阳性。
伯基特淋巴瘤；病例报告；胃；胸膜间皮瘤；胸腔积液；呼吸衰竭
