Fukuda T, Sato K, Tachikawa S, Ohnuki K, Ohtani H, Suzuki T
Second Department of Pathology, Fukushima Medical College, Japan.
Pathol Int. 1997 Dec;47(12):870-5. doi: 10.1111/j.1440-1827.1997.tb03720.x.
Malignant lymphoma arising in the stomach of a 23-year-old Japanese man with systemic sarcoidosis is presented. The patient was followed because of systemic sarcoidosis involving the lungs, eyes, and lymph nodes. Biopsy specimens from the stomach were repeated because of recurrent epigastralgia and multiple ulcerations. Some of the specimens revealed epithelioid granulomas with no caseous necrosis, which confirmed gastric involvement of sarcoidosis. Three years after the initial diagnosis, biopsy specimens taken from the stomach were diagnosed as malignant lymphoma of the large cell type. The resected stomach revealed multicentric mucosa-associated type malignant lymphoma of low-grade B cell type, with foci of high-grade transformation coexisting with numerous epithelioid granulomas with no caseous necrosis. Epithelioid granulomas were observed in all the respected lymph nodes, liver, and appendix, which had been obtained at operation, whereas malignant lymphoma was limited to the stomach. Helicobacter pylori (H. pylori) infection was also observed in the stomach. Consequently, the present report is a rare case of coexistence of malignant lymphoma and involvement of sarcoidosis in the stomach. Both H. pylori infection and active sarcoid nodules may play a role in the development of malignant lymphoma, although the exact mechanism remains unclear.
本文报告了一名23岁患有系统性结节病的日本男性胃内发生恶性淋巴瘤的病例。该患者因肺部、眼睛及淋巴结受累的系统性结节病而接受随访。因反复出现上腹部疼痛及多处溃疡，多次取胃活检标本。部分标本显示为无干酪样坏死的上皮样肉芽肿，证实结节病累及胃部。初次诊断三年后，取自胃部的活检标本被诊断为大细胞型恶性淋巴瘤。切除的胃显示为多中心黏膜相关型低级别B细胞型恶性淋巴瘤，伴有高级别转化灶，同时存在大量无干酪样坏死的上皮样肉芽肿。在手术获取的所有送检淋巴结、肝脏及阑尾中均观察到上皮样肉芽肿，而恶性淋巴瘤仅局限于胃部。胃内还检测到幽门螺杆菌（H. pylori）感染。因此，本报告是一例罕见的胃内恶性淋巴瘤与结节病并存的病例。尽管确切机制尚不清楚，但幽门螺杆菌感染及活跃的结节病结节可能在恶性淋巴瘤的发生中起作用。
