Gastric adenocarcinoma following gastric lymphoma. Role of partial gastrectomy.

Gastric adenocarcinoma developed in a 45-year-old man 13 years after he had undergone resection of a gastric lymphoma (large cleaved cell type, diffuse) and two courses of radiation therapy to the upper abdomen to a total dose of 6300 rad. Three factors involved in possibly increasing risk for the second malignancy, namely lymphoma, extensive radiation therapy, and gastric resection, are discussed. Degenerative and premalignant histologic changes occur in the gastric remnant after partial gastrectomy. These contribute to the pathogenesis of adenocarcinoma after surgical therapy of peptic ulcer or other disorders. Periodic endoscopic surveillance and the use of multiple biopsies are important in achieving early diagnosis.