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Phuong VT, Lieu DQ, Hanh BTM, Thu Hien HT, Khanh NV, Hang NT, Duc NM. Synchronous occurrence of gastric adenocarcinoma and MALT-type lymphoma: A case report and literature review. Radiol Case Rep 2023; 18:2730-2734. [PMID: 37304315 PMCID: PMC10250828 DOI: 10.1016/j.radcr.2023.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/05/2023] [Accepted: 05/12/2023] [Indexed: 06/13/2023] Open
Abstract
The coexistence of multiple primary malignant tumors in an organ is rare. This includes the extremely rarely reported combination of gastric adenocarcinoma and gastric MALT-type lymphoma as synchronous tumors. We describe a case of a 72-year-old man diagnosed with this combination. He had no remarkable medical history and came to our hospital because of discomfort in the gastric area. Although the biopsy revealed adenocarcinoma only, the microscopic findings after partial gastrectomy incidentally showed additional lymphoma that was subsequently confirmed by immunohistochemistry as MALT-type lymphoma. This case study and literature analysis aims to raise awareness of the possibility of synchronous malignant neoplasm in the stomach to enhance preoperative diagnosis.
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Affiliation(s)
- Vu-Thi Phuong
- Department of Laboratory, Pathology Division, Vinmec Times City International Hospital, Hanoi, Vietnam
| | - Dau Quang Lieu
- Department of Internal Medicine, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Bui Thi My Hanh
- Department of Pathology, Hanoi Medical University, Hanoi, Vietnam
| | - Ha-Thi Thu Hien
- Department of Laboratory, Pathology Division, Vinmec Times City International Hospital, Hanoi, Vietnam
| | - Nguyen-Van Khanh
- Department of Laboratory, Pathology Division, Vinmec Times City International Hospital, Hanoi, Vietnam
| | - Nguyen-Thi Hang
- Department of Laboratory, Pathology Division, Vinmec Times City International Hospital, Hanoi, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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Parra-Medina R, Rocha F, Castañeda-González JP, Moreno-Lucero P, Veloza L, Romero-Rojas AE. Synchronous or collision solid neoplasms and lymphomas: A systematic review of 308 case reports. Medicine (Baltimore) 2022; 101:e28988. [PMID: 35838994 PMCID: PMC11132339 DOI: 10.1097/md.0000000000028988] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/13/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The presence of a lymphoma associated with a solid synchronous neoplasm or collision neoplasm has been rarely in the literature, and a detailed characterization of these cases is lacking to date. OBJECTIVE To describe the main clinicopathological features of synchronous/collision tumors. METHODS A systematic search in PubMed, Scielo, and Virtual Health Library literature databases for cases or case series of synchronous or collision lymphoma and other solid neoplasms reported up to March 2021 was performed. Three reviewers independently screened the literature, extracted data, and assessed the quality of the included studies. The systematic review was performed following the Preferred Reporting Items for Systematic Meta-Analyses guidelines. RESULTS Mean age of patients was 62.9 years (52.9% men). A total of 308 cases were included (62% synchronous and 38% collision). The most frequent location of both synchronous and collision tumors was the gastrointestinal tract with the most common solid neoplasm being adenocarcinoma, and the most frequent lymphoma diffuse large B-cell lymphoma (21.7%) and mucosa-associated lymphoid tissue lymphoma (20.4%). Of the total number of mucosa-associated lymphoid tissue lymphomas and gastric adenocarcinomas, the presence of Helicobacter pylori infection was documented in 47.3% of them. Only 2% of all cases had a previous history of lymphoma. Thus, in most cases (98%), lymphoma was discovery incidentally. In addition, nodal lymphoma was associated with metastasis in 29 (9.4%) cases as collision tumor, most commonly (90%) in locoregional lymph nodes of the solid neoplasm. CONCLUSIONS The frequent association of some type of B-cell lymphoma and adenocarcinoma in synchronous/collision tumors of the gastrointestinal tract points to common pathogenic mechanisms in both neoplasia, particularly related to chronic inflammation in this location. In most cases, lymphoma identified in locoregional lymph nodes or distant of a carcinoma seems to represent an incidental finding during the carcinoma diagnostic/therapeutic approach. A synergy between carcinoma and lymphoma (involving inflammation and immunosuppression mechanisms) may favor tumor progression and dissemination. A better understating of the interactions lymphoma/carcinoma in the setting of synchronous/collision tumors may help to improve patient management and prognosis.
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Affiliation(s)
- Rafael Parra-Medina
- Department of Pathology, Fundación Universitaria de Ciencias de la Salud, Hospital San José, Bogotá, Colombia
- Research Institute, Fundación Universtaria de Ciencias de la Salud, Bogotá, Colombia
- Department of Pathology, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Franky Rocha
- Department of Pathology, Fundación Universitaria de Ciencias de la Salud, Hospital San José, Bogotá, Colombia
| | | | - Paula Moreno-Lucero
- Department of Pathology, Fundación Universitaria de Ciencias de la Salud, Hospital San José, Bogotá, Colombia
| | - Luis Veloza
- Institute of Pathology, Lausanne University Hospital, Lausanne University, Lausanne, Switzerland
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Rentien AL, Lévy M, Copie-Bergman C, Gagniere C, Dupuis J, Le Baleur Y, Belhadj K, Sobhani I, Haioun C, Delchier JC, Amiot A. Long-term course of precancerous lesions arising in patients with gastric MALT lymphoma. Dig Liver Dis 2018; 50:181-188. [PMID: 29102522 DOI: 10.1016/j.dld.2017.10.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/11/2017] [Accepted: 10/13/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS To evaluate the prevalence and the long-term course of gastric precancerous lesions in patients with GML. PATIENTS AND METHODS In this retrospective single-centre study, we included 179 patients with GML, 70 with gastric diffuse large B-cell lymphoma (GDLBCL) and 152 with Helicobacter pylori-associated gastritis (HpG), from January 1995 to January 2014. The presence of atrophic gastritis, intestinal metaplasia and neoplastic lesion has been assessed at baseline and during follow-up. RESULTS Atrophic gastritis was more frequent in the GML group whereas there was also a trend for intestinal metaplasia and gastric dysplasia. In patients with GML, atrophic gastritis, intestinal metaplasia and gastric dysplasia were more frequent in the GML area than in other part of the stomach. During follow-up, the prevalence of atrophic gastritis remained stable overtime whereas intestinal metaplasia and dysplasia tend to increase overtime. In multivariate analysis, the occurrence of dysplasia or carcinoma was associated with the presence of intestinal metaplasia at baseline and male gender. CONCLUSION GML is associated with gastric precancerous lesion to a higher extent than GDLBCL and HpG. Those precancerous lesions do not regress despite achievement of complete remission of GML and tend to increase overtime.
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Affiliation(s)
- Anne-Laure Rentien
- Department of Gastroenterology, Henri Mondor University Hospital, APHP, Creteil F-94010, France; Paris Est-Creteil University (UPEC), Creteil F-94010, France; EC2M3-EA7375 Unit, Creteil, France
| | - Michaël Lévy
- Department of Gastroenterology, Henri Mondor University Hospital, APHP, Creteil F-94010, France
| | - Christiane Copie-Bergman
- Paris Est-Creteil University (UPEC), Creteil F-94010, France; Department of Pathology, Henri Mondor University Hospital, APHP, Creteil F-94010, France; Unit UMR-S 955, INSERM, Creteil F-94010, France
| | - Charlotte Gagniere
- Department of Gastroenterology, Henri Mondor University Hospital, APHP, Creteil F-94010, France; Paris Est-Creteil University (UPEC), Creteil F-94010, France; EC2M3-EA7375 Unit, Creteil, France
| | - Jehan Dupuis
- Lymphoid Malignancies Unit, Henri Mondor University Hospital, APHP, Creteil F-94010, France
| | - Yann Le Baleur
- Department of Gastroenterology, Henri Mondor University Hospital, APHP, Creteil F-94010, France
| | - Karim Belhadj
- Lymphoid Malignancies Unit, Henri Mondor University Hospital, APHP, Creteil F-94010, France
| | - Iradj Sobhani
- Department of Gastroenterology, Henri Mondor University Hospital, APHP, Creteil F-94010, France
| | - Corinne Haioun
- Paris Est-Creteil University (UPEC), Creteil F-94010, France; Unit UMR-S 955, INSERM, Creteil F-94010, France; Lymphoid Malignancies Unit, Henri Mondor University Hospital, APHP, Creteil F-94010, France
| | - Jean-Charles Delchier
- Department of Gastroenterology, Henri Mondor University Hospital, APHP, Creteil F-94010, France; Paris Est-Creteil University (UPEC), Creteil F-94010, France
| | - Aurelien Amiot
- Department of Gastroenterology, Henri Mondor University Hospital, APHP, Creteil F-94010, France; Paris Est-Creteil University (UPEC), Creteil F-94010, France; EC2M3-EA7375 Unit, Creteil, France.
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Gastric collision tumors: an insight into their origin and clinical significance. Gastroenterol Res Pract 2015; 2015:314158. [PMID: 25767509 PMCID: PMC4342179 DOI: 10.1155/2015/314158] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 01/13/2015] [Accepted: 01/14/2015] [Indexed: 12/19/2022] Open
Abstract
Collision tumors are rare neoplasms displaying two distinct cell populations developing in juxtaposition to one another without areas of intermingling. They are rare entities with only 63 cases described in English literature. Tumors encountered are gastric adenocarcinomas colliding with lymphomas, gastrointestinal stromal tumors, squamous cell carcinomas, and neuroendocrine tumors. Their cell origin is obsolete by the time of diagnosis. Different tumorigenesis theories have been suggested to explain their behavior, yet none has managed to provide satisfactory explanation for all cases. Clinically they are indistinguishable from the dominant tumor. Lack of data does not allow detailed assessment of their behavior yet they seem aggressive neoplasms with dismal prognosis. The majority of cases have been diagnosed postoperatively during histologic examination of specimens. There are no guidelines or concrete evidence to support best way of adjuvant or other types of treatment. However, these rare neoplasms might help in unlocking secrets of cancer behavior including tumorigenesis, differentiation, and adhesion and thus clinicians should be aware of their existence.
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Vassos N, Agaimy A, Hohenberger W, Croner RS. Coexistence of gastrointestinal stromal tumours (GIST) and malignant neoplasms of different origin: prognostic implications. Int J Surg 2014; 12:371-7. [PMID: 24632413 DOI: 10.1016/j.ijsu.2014.03.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 03/11/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Over the past decade, several changes occurred in diagnostics, treatment and understanding of pathogenesis of gastrointestinal stromal tumours (GIST). However, their coexistence with other malignancies of different histogenetic origin remains a challenging issue. METHODS Patients diagnosed with GIST in a 10-years period were identified retrospectively and clinical history and findings thoroughly explored for the presence of associated other malignancies. Follow up data were obtained and analysed for prognostic impact of the concurrent malignancy and/or GIST. RESULTS Thirty seven (27 males, 10 females) of 86 GIST-patients (43%) had another malignancy. Mean age was 70 years. Associated malignancies were gastrointestinal (n = 29; 69%), renal-/urological (n = 5; 12%), haematological (n = 4; 9.5%), cutaneous (n = 3; 7%) and thyroid (n = 1; 2.5%) in origin. Majority of GISTs occurred in stomach (65%) and small intestine (30.6%) and most (78%) were asymptomatic incidental findings during diagnostic or therapeutic procedures for associated malignancies. GIST size ranged from 0.1 cm to 9 cm (mean, 2.2 cm) and all of them had a low (<5/50 HPFs) or no mitotic activity. Thirty-one tumours (84%) were of no/very low/low risk and 6 were of intermediate risk. During follow-up (range 3-160 months, mean; 60 months), one patient suffered from distant metastases of GIST. Seven patients (19%) died of associated malignancies and three patients (8%) of other non-tumour-associated cause, but none died of GIST. CONCLUSION Coexistence of GIST with other malignancies is higher than previously reported and should draw attention of clinicians towards these incidental findings. Prognosis in these patients is usually determined by other malignancy and not significantly influenced by GIST. Therefore treatment algorithms should be focused on prognostically relevant malignancy.
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Affiliation(s)
- Nikolaos Vassos
- Department of Surgery, University Hospital, Erlangen, Germany.
| | - Abbas Agaimy
- Department of Pathology, University Hospital, Erlangen, Germany
| | | | - Roland S Croner
- Department of Surgery, University Hospital, Erlangen, Germany
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Adrish M, Venkatram S, Niazi M, Diaz-Fuentes G. Concurrent lung squamous cell carcinoma and extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue type. J Bronchology Interv Pulmonol 2014; 21:96-99. [PMID: 24419198 DOI: 10.1097/lbr.0000000000000038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The coexistence of primary lung cancer and lymphoma is a rare finding. We present a case of a 66-year-old woman with marginal B-cell lymphoma of mucosa-associated lymphoid tissue type with lung, mediastinal lymph node, and bone marrow involvement. Surveillance imaging after treatment for lymphoma revealed persistent uptake by positron emission tomography scan. A transbronchial biopsy revealed the marginal B-cell lymphoma and a well-differentiated invasive squamous cell carcinoma. Management was changed to address new pathologic findings.
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Affiliation(s)
- Muhammad Adrish
- *Division of Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center †Clinical Medicine at Albert Einstein College of Medicine, Division of Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center (Affiliated with Albert Einstein College of Medicine) ‡Department of Pathology, Bronx Lebanon Hospital Center (Affiliated with Albert Einstein College of Medicine), Bronx, NY
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George SA, Junaid T. Gastric marginal zone lymphoma of mucosa-associated lymphoid tissue and signet ring cell carcinoma, synchronous collision tumour of the stomach: a case report. Med Princ Pract 2014; 23:377-9. [PMID: 24247357 PMCID: PMC5586883 DOI: 10.1159/000356180] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 10/01/2013] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To report a rare case of synchronous marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) signet ring cell carcinoma occurring as a collision tumour in the stomach. CLINICAL PRESENTATION AND INTERVENTION A 53-year-old man was diagnosed initially with signet ring cell carcinoma of the stomach. The microscopy of the subsequent total gastrectomy revealed a collision tumour of MALT lymphoma and signet ring cell carcinoma associated with Helicobacter pylori gastritis. CONCLUSION This case highlighted the importance of a careful evaluation of the accompanying lymphoid population in the biopsy samples of gastric adenocarcinoma and underlined the need for multiple endoscopic biopsies to detect these rare synchronous tumours.
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Affiliation(s)
- Smiley Annie George
- Department of Histopathology, Mubarak Al-Kabir Hospital, Kuwait University, Jabriya, Kuwait
- *Dr. Smiley Annie George, Department of Histopathology, Mubarak Al-Kabir Hospital, Jabriya, Kuwait City (Kuwait), E-Mail
| | - T.A. Junaid
- Department of Histopathology, Mubarak Al-Kabir Hospital, Kuwait University, Jabriya, Kuwait
- Department of Pathology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
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Inaba K, Kushima R, Murakami N, Kuroda Y, Harada K, Kitaguchi M, Yoshio K, Sekii S, Takahashi K, Morota M, Mayahara H, Ito Y, Sumi M, Uno T, Itami J. Increased risk of gastric adenocarcinoma after treatment of primary gastric diffuse large B-cell lymphoma. BMC Cancer 2013; 13:499. [PMID: 24159918 PMCID: PMC3816307 DOI: 10.1186/1471-2407-13-499] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 09/12/2013] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND There have been sporadic reports about synchronous as well as metachronous gastric adenocarcinoma and primary gastric lymphoma. Many reports have dealt with metachronous gastric adenocarcinoma in mucosa-associated lymphoid tissue lymphoma of stomach. But to our knowledge, there have been no reports that document the increased incidence of metachronous gastric adenocarcinoma in patients with gastric diffuse large B-cell lymphoma. This retrospective study was conducted to estimate the incidence of metachronous gastric adenocarcinoma after primary gastric lymphoma treatment, especially in diffuse large B-cell lymphoma. METHODS The retrospective cohort study of 139 primary gastric lymphoma patients treated with radiotherapy at our hospital. Mean observation period was 61.5 months (range: 3.7-124.6 months). Patients profile, characteristics of primary gastric lymphoma and metachronous gastric adenocarcinoma were retrieved from medical records. The risk of metachronous gastric adenocarcinoma was compared with the risk of gastric adenocarcinoma in Japanese population. RESULTS There were 10 (7.2%) metachronous gastric adenocarcinoma patients after treatment of primary gastric lymphomas. It was quite high risk compared with the risk of gastric carcinoma in Japanese population of 54.7/100,000. Seven patients of 10 were diffuse large B-cell lymphoma and other 3 patients were mixed type of diffuse large B-cell lymphoma and mucosa associated lymphoid tissue lymphoma. Four patients of 10 metachronous gastric adenocarcinomas were signet-ring cell carcinoma and two patients died of gastric adenocarcinoma. Metachronous gastric adenocarcinoma may have a more malignant potential than sporadic gastric adenocarcinoma. Old age, Helicobacter pylori infection and gastric mucosal change of chronic gastritis and intestinal metaplasia were possible risk factors for metachronous gastric adenocarcinoma. CONCLUSION There was an increased risk of gastric adenocarcinoma after treatment of primary gastric lymphoma, especially of diffuse large B-cell lymphoma.
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Affiliation(s)
- Koji Inaba
- Department of Radiation Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
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Shin DW, Kim H, Kim H, Kwon MH, Kim SD, Bae SH, Kwon JC, Rhee JA, Han MH. Synchronous, Orthotopic Occurrence of Early Gastric Cancer with Gastrointestinal Stromal Tumor that Mimicked Advanced Gastric Cancer. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2013. [DOI: 10.7704/kjhugr.2013.13.3.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Dong Woo Shin
- Division of Gastroenterology, Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Hyunsoo Kim
- Division of Gastroenterology, Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Hyunji Kim
- Division of Gastroenterology, Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Moon Hyuk Kwon
- Division of Gastroenterology, Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Sang Dong Kim
- Division of Gastroenterology, Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Soo Hyun Bae
- Division of Gastroenterology, Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Jae Choon Kwon
- Division of Gastroenterology, Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Jung-Ahn Rhee
- Department of General Surgery, Daegu Fatima Hospital, Daegu, Korea
| | - Man Hoon Han
- Department of Pathology, Daegu Fatima Hospital, Daegu, Korea
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Bhattacharya A, Saha R, Biswas J, Biswas J, Ghosh B. Collision tumors in the gastrointestinal tract: a rare case series. Int Med Case Rep J 2012; 5:73-7. [PMID: 23754928 PMCID: PMC3658259 DOI: 10.2147/imcrj.s35818] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
A collision tumor is one where histology shows the presence of two distinct primaries involving the same organ without intermixture of individual cell types, ie, a side by side pattern. Here we present three rare cases of collision tumors involving the stomach and transverse colon. There were two cases of collision tumors involving the stomach, one of which was a combination of adenocarcinoma and low-grade non-Hodgkin’s (mucosa-associated lymphoid tissue) lymphoma, and the other showed the presence of non-Hodgkin’s lymphoma involving the entire stomach wall along with adenocarcinoma infiltrating the muscle layer. The third case comprised a mucinous adenocarcinoma and carcinoid tumor in the large gut.
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Jung CY, Kwon KY. A Case of Synchronous Lung Adenocarcinoma and Extranodal Marginal Zone B-Cell Lymphoma of Mucosa-Associated Lymphoid Tissue (MALT) Type. Tuberc Respir Dis (Seoul) 2012; 73:61-6. [PMID: 23101026 PMCID: PMC3475473 DOI: 10.4046/trd.2012.73.1.61] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 04/24/2012] [Accepted: 05/18/2012] [Indexed: 11/24/2022] Open
Abstract
Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue type (extranodal MZL) is a distinct subgroup of non-Hodgkin's lymphoma. Pulmonary extranodal MZL is a rare entity and accounts for less than 0.5% of primary pulmonary malignancies. Only a few cases of simultaneous occurrence of lung cancer and pulmonary extranodal MZL have been reported. A 60-year-old woman was referred to our hospital with a pulmonary nodule. She was diagnosed with lung adenocarcinoma by percutaneous needle biopsy. The protrusions into the left main bronchus were found by accident while performing bronchoscopy during lung cancer evaluation. The bronchial lesions were diagnosed as extranodal MZL. Although the patient underwent surgical resection for the lung adenocarcinoma, the pulmonary extranodal MZL was left untreated; it was monitored during follow-up visits. To our knowledge, this is the first report of synchronous lung adenocarcinoma and primary extranodal MZL of the main bronchus.
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Affiliation(s)
- Chi Young Jung
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
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12
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Park JH, Jang JY, Cho YD, Dong SH, Kim HJ, Kim BH, Chang YW. [A case of synchronous early gastric cancer and diffuse large B cell lymphoma treated with endoscopic submucosal dissection and chemotherapy]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2012; 59:377-81. [PMID: 22617533 DOI: 10.4166/kjg.2012.59.5.377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Among malignant tumors of the stomach, adenocarcinoma takes up about 95% and the remaining are mostly lymphomas, being less than 5%. The majority of lymphomas are B cell lymphomas, and the most common types are low-grade B cell lymphoma of mucosa-associated lymphoid tissue and diffuse large B cell lymphoma (DLBL). The synchronous occurrence of adenocarcinoma and lymphoma in the stomach is being reported rarely. Especially the concurrence of adenocarcinoma and DLBL is very scarce and less than 10 cases have been reported inside and outside this country. In the past, the general treatment for cases of concurrence of adenocarcinoma and DLBL when surgery is possible according to cancer stages was gastrectomy, followed by single or combined chemotherapy and radiation treatment. However, when considering that most cases of concurrent adenocarcinoma were early gastric cancer which is limited to the mucosa, endoscopic submucosal dissection (ESD) can become an alternative treatment method for gastrectomy. We report the experience with chemotherapy and ESD done together instead of surgery, in patients concurrently diagnosed with early gastric cancer and gastric lymphoma.
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Affiliation(s)
- Jae Hyun Park
- Department of Internal Medicine, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 130-702, Korea
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13
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Cui Y, Liu T, Zhou Y, Ji Y, Hou Y, Jin W, Feng Y. Five cases report of solid tumor synchronously with hematologic malignancy. Cancer Res Treat 2012; 44:63-8. [PMID: 22500163 PMCID: PMC3322203 DOI: 10.4143/crt.2012.44.1.63] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 01/28/2011] [Indexed: 11/21/2022] Open
Abstract
The reported incidence of synchronous multiple primary cancer (SMPC) is rare, and it is even less common to observe synchronous solid tumor with a hematological malignancy. We report five cases of solid tumor presented synchronously with hematological malignancy, all observed within a 2 year period at the oncology department of a university hospital in Shanghai, China. These individual cases included lung adenocarcinoma with chronic myelogenous leukemia, colon cancer with solitary plasmocytoma, gastric adenocarcinoma with diffuse large B cell non-Hodgkin's lymphoma, lung adenocarcinoma with multiple myeloma, and colon cancer with diffuse large B cell non-Hodgkin's lymphoma. It is challenging to therapeutically control the biological behavior of concurrent multiple primary tumors, and there is no standard treatment for such rare conditions. In this paper we discuss these five cases of SMPC and their treatments.
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Affiliation(s)
- Yuehong Cui
- Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
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Gisbert JP, Calvet X. Review article: common misconceptions in the management of Helicobacter pylori-associated gastric MALT-lymphoma. Aliment Pharmacol Ther 2011; 34:1047-62. [PMID: 21919927 DOI: 10.1111/j.1365-2036.2011.04839.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Helicobacter pylori infection is the main cause of gastric mucosa-associated lymphoid tissue (MALT) lymphoma. AIM To review several common misconceptions in the management of H. pylori-associated gastric MALT-lymphoma. METHODS Bibliographical searches were performed in MEDLINE up to June 2011. RESULTS If adequate diagnostic methods are used, and if only low-grade lymphomas are considered, the prevalence of H. pylori infection is very high (almost 90%). H. pylori eradication is effective in treating approximately 80% of patients with early stage lymphoma. In H. pylori-positive gastric high-grade lymphomas, antibiotic therapy should always be prescribed, as approximately 50% of them regress after H. pylori eradication. Patients with early stage MALT lymphoma negative for H. pylori might still benefit from antibiotic treatment as the sole treatment. Complete remission of gastric MALT lymphoma after H. pylori eradication can take even >12 months. PCR assay for the detection of monoclonal B cells remains positive in many cases after complete remission has been reached. Patients with a persistent clonal band should not be treated unless the lymphoma can be histologically demonstrated. Synchronous occurrence of gastric adenocarcinoma and MALT lymphoma has been repeatedly reported. In some patients in complete remission, eradication of H. pylori does not prevent later development of early gastric cancer. Gastric lymphoma recurrence occurs in some patients after both bacterial and lymphoma regression. H. pylori reinfection does not constitute a prerequisite for lymphoma recurrence. CONCLUSIONS The present article states several misconceptions in the management of H. pylori-associated gastric MALT-lymphoma in clinical practice, reviews the related scientific evidence and proposes the adequate attitude in each case.
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Affiliation(s)
- J P Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain.
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Park SY, Eun CS, Byun YS, Yoon JY, Jeon YC, Han DS, Sohn JH, Oh YH. [A case of synchronous double primary cancer of gastric adenocarcinoma and diffuse large B cell lymphoma]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2011; 57:115-9. [PMID: 21350322 DOI: 10.4166/kjg.2011.57.2.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The simultaneous occurrence of primary gastric lymphoma and adenocarcinoma is rarely reported. We here report a case of synchronous double primary tumor of advanced gastric cancer and diffuse large B cell lymphoma. A 65-year-old woman underwent an esophagogastroduodenoscopy for the evaluation of abdominal discomfort of two months' duration. The endoscopic examination showed an ulcerating tumor in the gastric antrum and thickened folds in the fundus and the microscopic examination revealed an adenocarcinoma in the antrum and a diffuse large B-cell lymphoma in the fundus. She has had total gastrectomy and CHOP chemotherapy with rituximab. Since the cases of synchronous double primary gastric tumors have been increased on the recent medical advances, when a gastric tumor is detected for the endoscopic examination, an endoscopist has to make every endeavor not to miss another tumor in the stomach.
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Affiliation(s)
- Soo Yuck Park
- Department of Internal Medicine, Hanyang University College of Medicine, Guri, Korea
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16
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Ohno H. Coexistence of mucosa-associated lymphoid tissue lymphoma with plasma cell features and adenocarcinoma cells in pleural fluid. J Clin Exp Hematop 2010; 50:75-7. [PMID: 20505280 DOI: 10.3960/jslrt.50.75] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Jang KY, Park HS, Chung MJ, Moon WS, Kang MJ, Lee DG, Kim YK, Kim CY. Synchronous occurrence of primary adenocarcinoma and schwannoma in the stomach: a case report. Pathology 2009; 41:286-9. [PMID: 19291543 DOI: 10.1080/00313020902756386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Synchronous Pulmonary MALT Lymphoma and Pulmonary Adenocarcinoma after Metachronous Gastric MALT Lymphoma and Gastric Adenocarcinoma. J Thorac Oncol 2008; 3:1362-3. [DOI: 10.1097/jto.0b013e31818b1b07] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Strofilas A, Dalianoudis IG, Lagoudianakis EE, Genetzakis M, Tsekouras D, Chrysikos J, Koronakis N, Katergiannakis V, Manouras A. Collision tumour of the stomach with a cancer to cancer metastasis: a case report. CASES JOURNAL 2008; 1:63. [PMID: 18662400 PMCID: PMC2503961 DOI: 10.1186/1757-1626-1-63] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Accepted: 07/28/2008] [Indexed: 11/11/2022]
Abstract
Introduction Coexistence of a primary gastric lymphoma and a gastric adenocarcinoma is a rare event. The diagnosis is suspected after the pathologic examination of the endoscopic biopsies and definitely documented with the examination of the surgical specimen. Case presentation We are presenting a rare case of a 77-year-old Greek man with epigastric pain of one and a half month duration, nausea, anorexia and weight loss. The pathologic examination of the endoscopic biopsies and a lymph node biopsy excised at laparotomy, presented the interpenetration of synchronous occurring primary gastric lymphoma and a gastric adenocarcinoma with a documented cancer to cancer metastasis. Conclusion Prognosis of these rare tumours is largely dependent on the stage of the adenocarcinoma at presentation but due to lack of large series there are no data on the biological behavior of these tumours in comparison to adenocarcinoma.
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Delchier JC, Lévy M. Prise en charge clinique et thérapeutique du lymphome gastrique du MALT. ONCOLOGIE 2008. [DOI: 10.1007/s10269-008-0911-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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21
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Yamaguchi T, Takahashi H, Kagawa R, Takeda R, Sakata S, Yamamoto M, Nishizaki D, Yasui H. Synchronous Mucosa-Associated Lymphoid Tissue Lymphoma and Gastrointestinal Stromal Tumor of the Stomach Presenting with Gastric Bleeding. Am Surg 2008. [DOI: 10.1177/000313480807400311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report an extraordinarily rare case of synchronous mucosa-associated lymphoid tissue lymphoma and gastrointestinal stromal tumor of the stomach. An 80-year-old man presented with gastric bleeding. Gastroscopy showed an ulcerative lesion and a submucosal tumor at the upper corpus of the stomach. The ulcerative lesion was proven by biopsy to be mucosa-associated lymphoid tissue lymphoma, but the submucosal tumor could not be diagnosed. Due to the repeating episodes of massive gastric bleeding, a total gastrectomy with lymphadenectomy was performed. After the operation, the submucosal tumor was pathologically proven to be a gastrointestinal stromal tumor. In this case, synchronous occurrence of mucosa-associated lymphoid tissue lymphoma and gastrointestinal stromal tumor seems to be coincidental rather than related with the same pathogenic triggering. Surgical resection of the stomach provided an accurate diagnosis and an effective treatment.
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KYCLER W, TERESIAK M, ŚLIWIŃSKI A. An unusual case of synchronous lymphoma and adenocarcinoma occurring as a collision tumour in the stomach – a case report. Rep Pract Oncol Radiother 2008. [DOI: 10.1016/s1507-1367(10)60088-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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23
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Pamukçuoglu M, Budakoğlu B, Han O, Tad M, Oksüzoğlu B, Abali H, Zengin N. An extraordinary case in whom gastrointestinal stromal tumor and low-grade malignant lymphoma are seen together in the stomach. Med Oncol 2008; 24:351-3. [PMID: 17873313 DOI: 10.1007/s12032-007-0001-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2007] [Revised: 11/30/1999] [Accepted: 02/22/2007] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Gastrointestinal system (GIS) is the most common site of involvement of all primary extranodal lymphomas. Gastric lymphoma constitutes 3-6% of all primary stomach malignancies. Stomach is also the commonest site of involvement of gastrointestinal stromal tumors (GIST). We would like to report these rare synchronous tumors in the same patient. CASE A 68-year-old male was admitted to the internal medicine clinics with the complaints of abdominal distension. Physical examination was normal. On abdominal computed tomography a 12 x 14 x 22 cm sized giant tumoral mass was detected in left hypochondrium. A total gastrectomy was performed. Two distinct neoplasms were detected; one of which was located in the posterior wall of the stomach with the size of 24 x 16 x 13 cm, and the other one was localized in the fundus of the stomach and its size was 6 x 5 x 2 cm. Pathological evaluation revealed the diagnosis of GIST at the posterior wall and low-grade malignant lymphoma from the mass localized in the fundus of the stomach. DISCUSSION Two primary tumors are not seen so often together in the stomach. Adenocarcinoma and associated tumors including gastric lymphoma (especially MALT lymphoma), carcinoid, leiomyosarcoma and rhabdomyosarcoma constitute most of the reported series. Rarely adenocarcinoma and associated GIST cases were reported. It is important to report concurrent gastric lymphoma and GIST case since it is extremely rare in the English literature.
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Affiliation(s)
- Merve Pamukçuoglu
- Uçüncü Dahiliye Kliniği, Ankara Numune Eğitim ve Araştirma Hastanesi, Ankara, Turkey.
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24
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Abstract
Synchronous occurrence of mantle cell lymphoma (MCL) and gastric cancer in the same patient has not yet been reported in the English literature. MCL comprises 2.5-7% of non-Hodgkin's lymphomas and is characterized by a poor prognosis with a median survival probability of 3-4 years in most series. A 62-year-old man was referred to our hospital for evaluation of an abnormal gastric lesion. The endoscopic finding was compatible with type IIc early gastric cancer (EGC) in the middle third of the stomach, and a biopsy of the lesion proved to be carcinoma. Radical total gastrectomy with splenectomy and Roux-en-Y esophagojejunostomy were performed. The resected specimen revealed two grossly separated lesions. Postoperative histological examination reported both adenocarcinoma and MCL. Immunohistochemical staining showed positivity for CD5, CD20, and cyclin D1 in the infiltrated lymphoid cells. MCL is an aggressive non-Hodgkin's lymphoma, and the current treatment approach is still unsatisfactory. Further advancements in the understanding of the synchronous occurrence of both diseases, and more efforts on investigations of treatment are needed.
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Affiliation(s)
- Yong Il Kim
- Department of Surgery, Ewha Womans University College of Medicine, 70 Chongro-6ga, Chongro-gu, Seoul 110-787, Korea.
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25
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Lee FY, Jan YJ, Wang J, Yu CC, Wu CC. Synchronous gastric gastrointestinal stromal tumor and signet-ring cell adenocarcinoma: a case report. Int J Surg Pathol 2007; 15:397-400. [PMID: 17913950 DOI: 10.1177/1066896907302369] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Synchronous tumors of the stomach are uncommon. We present a unique case of gastric synchronous tumors composed of signet-ring cell adenocarcinoma and gastrointestinal stromal tumor (GIST). The two tumors arose at the same site and were sharply juxtaposed without intermingling of morphologically distinct elements. Coincidence probably accounts for this occurrence, even if a common carcinogenic agent had been hypothesized. Preoperative imaging and endoscopic biopsy could lead to the suspicion of synchronous tumors, and an accurate histological identification of both tumors could be achieved by multiple deep endoscopic biopsies. The presence in our case of diffuse carcinomatosis indicates that the signet-ring cell adenocarcinoma had a greater adverse effect on the prognosis than the GIST.
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MESH Headings
- Aged, 80 and over
- Biomarkers, Tumor/metabolism
- Biopsy
- Carcinoma, Signet Ring Cell/diagnosis
- Carcinoma, Signet Ring Cell/metabolism
- Carcinoma, Signet Ring Cell/surgery
- Endoscopy, Gastrointestinal
- Gastrointestinal Stromal Tumors/diagnosis
- Gastrointestinal Stromal Tumors/metabolism
- Gastrointestinal Stromal Tumors/surgery
- Humans
- Keratins/metabolism
- Male
- Mucins/metabolism
- Neoplasms, Multiple Primary/diagnosis
- Neoplasms, Multiple Primary/metabolism
- Neoplasms, Multiple Primary/surgery
- Periodic Acid-Schiff Reaction
- Stomach Neoplasms/diagnosis
- Stomach Neoplasms/metabolism
- Stomach Neoplasms/surgery
- Tomography, X-Ray Computed
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Affiliation(s)
- Fang-Yi Lee
- Department of Pathology, Taichung Veterans Genral Hospital, College of Medicine, Chung Shan Medical University, No. 160 Section 3 Chung-Kang Road, Taichung, Taiwan 00407, ROC.
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26
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Agaimy A, Wünsch PH, Sobin LH, Lasota J, Miettinen M. Occurrence of other malignancies in patients with gastrointestinal stromal tumors. Semin Diagn Pathol 2007; 23:120-9. [PMID: 17193825 DOI: 10.1053/j.semdp.2006.09.004] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Almost one-third of gastrointestinal stromal tumors (GISTs) are discovered incidentally during investigative or therapeutic procedures for unrelated diseases. In this regard, GISTs may coexist with different types of cancer, either synchronously or metachronously. The frequency of this association and the spectrum of neoplasms involved have not been sufficiently analyzed. We conducted a review of the literature and our own records for cases with sporadic GISTs and other malignancies, with emphasis on solid tumors. Neurofibromatosis 1 and Carney triad-associated tumors were excluded. Based on these data, there were 518 cancers in 486 GIST patients among 4813 cases with informative data. The overall frequency of second tumors in different series varied from 4.5% to 33% (mean, 13%). A total of 29 patients had multiple malignancies. GISTs of gastric location were most commonly involved with other neoplasms, reflecting their overall high frequency (60%) of all GISTs. The major types of GIST-associated cancers were gastrointestinal carcinomas (n=228; 47%), lymphoma/leukemia, (n=36; 7%), and carcinomas of prostate (n=43; 9%), breast (n=34; 7%), kidney (n=27; 6%), lung (n=26; 5%), female genital tract (n=25; 5%), and carcinoid tumors (n=13; 3%). Other cancers included soft tissue and bone sarcomas (n=15; 3%), malignant melanoma (n=12; 2%), and seminoma (n=6; 1%). Occurrence of collision tumors and metastases of carcinoma or sarcoma into a GIST (the latter noted in 4 cases) can be challenging diagnostic problems. The potential nonrandom association and causal relationship between GIST and other neoplasms remain to be investigated.
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Affiliation(s)
- Abbas Agaimy
- Institute of Pathology, Nuremberg Clinic Center, Nuremberg, Germany.
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27
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Bacon CM, Du MQ, Dogan A. Mucosa-associated lymphoid tissue (MALT) lymphoma: a practical guide for pathologists. J Clin Pathol 2006; 60:361-72. [PMID: 16950858 PMCID: PMC2001121 DOI: 10.1136/jcp.2005.031146] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) is the third most common non-Hodgkin lymphoma subtype, accounting for around 6-8% of all non-Hodgkin lymphomas in the Western hemisphere. Although MALT lymphomas are clinically indolent, the disease is typically chronic, requiring long-term clinical surveillance and, often, repeated biopsies. Pathologists thus play a central role in the diagnosis and management of these patients. The optimal diagnosis and management of a MALT lymphoma requires careful integration of morphological, immunohistochemical and molecular information, together with close cooperation with the clinician treating the patient. This review discusses recent developments in the molecular pathogenesis of MALT lymphoma and provides strategies for integrating this information into daily pathological practice.
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Affiliation(s)
- Chris M Bacon
- Department of Pathology, University of Cambridge, Cambridge, UK
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Lamarque D, Levy M, Chaumette MT, Roudot-Thoraval F, Cavicchi M, Auroux J, Courillon-Mallet A, Haioun C, Delchier JC. Frequent and rapid progression of atrophy and intestinal metaplasia in gastric mucosa of patients with MALT lymphoma. Am J Gastroenterol 2006; 101:1886-93. [PMID: 16780555 DOI: 10.1111/j.1572-0241.2006.00671.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Association of gastric mucosa-associated lymphoid tissue (MALT) low-grade lymphoma and adenocarcinoma has repeatedly been reported. The aim of this study was to evaluate the frequency and the spreading of atrophy and intestinal metaplasia in gastric mucosa of patients with gastric MALT lymphoma followed after conservative treatment. METHODS Forty-five patients (mean age 45 +/- 2.1 yr) with gastric MALT lymphoma, treated by Helicobacter pylori eradication, chemotherapy with per os single alkylating agents, or both treatments have been followed by gastroscopy with biopsies in antrum and corpus at least once a year. Univariate and multivariate analysis evaluated the association between the appearance of atrophy and intestinal metaplasia in antrum or corpus and different factors related to patients, H. pylori status, lymphoma features, and treatment. In addition, histological aspects of gastric biopsies at the diagnosis period and at the end of follow-up were compared with those of two control groups of age-matched patients with H. pylori gastritis. RESULTS At the diagnosis time, only intestinal metaplasia in corpus was more frequent in patients with gastric MALT lymphoma than in patients with nonulcer dyspepsia. Within median follow-up of 54.4 months (range 9-196), the percentage of patients with gastric atrophy and intestinal metaplasia increased significantly and became significantly higher than in age-matched nonulcer dyspepsia patients. Multivariate analysis showed significant association between corpus intestinal metaplasia and corpus atrophy, intestinal metaplasia in antrum, and duration of the follow-up. CONCLUSIONS Conservative management of gastric MALT lymphoma including H. pylori eradication is associated with progression of gastric atrophy and intestinal metaplasia with frequent involvement of the corpus which is known to be a precancerous condition. These findings show that long-term endoscopic monitoring should be recommended in such patients.
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Affiliation(s)
- Dominique Lamarque
- Service d'Hépato-Gastroentérologie, AP-HP Hôpital Henri Mondor, Créteil, France
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Hamaloglu E, Topaloglu S, Ozdemir A, Ozenc A. Synchronous and metachronous occurrence of gastric adenocarcinoma and gastric lymphoma: A review of the literature. World J Gastroenterol 2006; 12:3564-74. [PMID: 16773713 PMCID: PMC4087572 DOI: 10.3748/wjg.v12.i22.3564] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The occurrence of both primary gastric lymphoma and gastric adenocarcinoma in the same patient is a rare entity. The possible causative factors of synchronous or metachronous occurrence of both malignancies and varieties in the treatment modalities are reviewed according to published cases in English language medical literature.
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Affiliation(s)
- Erhan Hamaloglu
- Department of Surgery, School of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey
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30
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Salar A, Ramón JM, Barranco C, Nieto M, Prats M, Serrano S, Besses C. Double diagnosis in cancer patients and cutaneous reaction related to gemcitabine: CASE 1. Synchronous mucosa-associated lymphoid tissue lymphoma and gastrointestinal stromal tumors of the stomach. J Clin Oncol 2005; 23:7221-3. [PMID: 16192606 DOI: 10.1200/jco.2005.08.158] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Antonio Salar
- Department of Clinical Hematology, Hospital del Mar, Barcelona, Spain
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31
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Lee SY, Kim JJ, Lee JH, Kim YH, Rhee PL, Paik SW, Rhee JC, Ko YH. Synchronous Adenocarcinoma and Mucosa-associated Lymphoid Tissue (MALT) Lymphoma in a Single Stomach. Jpn J Clin Oncol 2005; 35:591-4. [PMID: 16254039 DOI: 10.1093/jjco/hyi164] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Synchronous gastric adenocarcinoma and primary gastric mucosa-associated lymphoid tissue (MALT) lymphoma are rare, and the characteristics of these tumors are still unclear. METHODS Histology of endoscopic and surgical specimens of 6012 gastric adenocarcinoma and 25 primary gastric MALT lymphoma cases were reviewed. RESULTS Five cases of synchronous tumors were found among 25 primary gastric MALT lymphoma patients (20.0%) and among 6012 gastric adenocarcinoma patients (8.3%). Helicobacter pylori was detected only in two cases (40.0%) of these five synchronous cases. In only one case, two types of malignant cells were mingled each other as a colliding tumor. In other four cases, two pathologies coexisted separately. These two types of malignant tumors were not distinguished by endoscopic or gross findings. CONCLUSIONS Although gastric adenocarcinoma coexists with MALT lymphoma at a relatively high frequency, synchronous carcinoma can be misinterpreted as a multifocal separated lesion of MALT lymphoma owing to their macroscopic resemblance. Therefore, gastric MALT lymphoma patients should be carefully examined by endoscopy, and any suspicious area must be biopsied considering the possibility of coexisting adenocarcinoma. In addition, etiologies other than H. pylori should be considered in these synchronous tumors.
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Affiliation(s)
- Sun-Young Lee
- Department of Medicine, Konkuk University College of Medicine, Seoul, Korea
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32
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Copie-Bergman C, Locher C, Levy M, Chaumette MT, Haioun C, Delfau-Larue MH, Leroy K, Gaulard P, Delchier JC. Metachronous gastric MALT lymphoma and early gastric cancer: is residual lymphoma a risk factor for the development of gastric carcinoma? Ann Oncol 2005; 16:1232-6. [PMID: 15890667 DOI: 10.1093/annonc/mdi242] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Helicobacter pylori plays a major role in the pathogenesis of primary gastric MALT lymphoma (GML) and gastric carcinoma. The occurrence of these two diseases metachronously in a same patient is a rare event. PATIENTS AND METHODS Gastric biopsies and gastrectomy resection specimens of four patients who developed GML and early gastric cancer (EGC) were analysed by morphology, immunohistochemistry and molecular biology. RESULTS Four patients (three males and one female; mean age 48 years) were diagnosed with GML. Helicobacter pylori infection was observed in three cases. Two patients had localized disease (stages IE and IIE, respectively) and were treated with H. pylori eradication therapy followed by an alkylating agent for one patient. Two patients had disseminated disease (stage IV), and were treated with an alkylating agent. Three cases were t(11;18) positive. All patients achieved initially complete lymphoma remission. Long-term endoscopic surveillance detected an EGC at the same location as the lymphoma in all patients at a mean time of 9.5 years (range 2.5-17 years) after lymphoma diagnosis. Gastrectomy specimens showed residual GML in all cases. CONCLUSION Prolonged residual GML could constitute an additional risk factor for the development of gastric carcinoma. Long-term endoscopic surveillance is mandatory in patients treated conservatively for gastric MALT lymphoma.
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Affiliation(s)
- C Copie-Bergman
- Departement de Pathologie, Service d'Hépato-Gastroentérologie, Service d'Hématologie Clinique, Service d'Immunologie Biologique, Hôpital Henri Mondor, AP-HP, 51 avenue du Maréchal de Lattre de Tassigny, France
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Vicente Baz D, Contreras JA, Maestro E, Añón MJ. [Collision tumour. adenocarcinoma and synchronous MALT gastric lymphoma]. Med Clin (Barc) 2005; 124:318-9. [PMID: 15755401 DOI: 10.1157/13072335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Milne ANA, Carvalho R, van Rees BP, van Lanschot JJB, Offerhaus GJA, Weterman MAJ. Do collision tumors of the gastroesophageal junction exist? A molecular analysis. Am J Surg Pathol 2005; 28:1492-8. [PMID: 15489653 DOI: 10.1097/01.pas.0000138184.74496.4d] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Collision tumors are thought to arise from the accidental meeting of two independent tumors. Here we present five gastroesophageal junction tumors consisting of two collision tumors and three composite tumors (characterized by two divergent lineages originating from the same neoplastic clonal proliferation), as diagnosed on histology. In an attempt to prove this distinction at a genetic level, we performed TP53 sequence analysis and p53 immunohistochemistry. In addition, loss of heterozygosity (LOH) analysis using 10 microsatellite markers was carried out. An identical TP53 mutation and a similar pattern of retention and LOH were found in both neoplastic components of the presumed collision tumors, suggesting that both components are derived from a single precursor cell that undergoes divergent differentiation in the evolution of the tumor. In the composite group, 1 case had a genetic basis for the possible diagnosis of a collision tumor, with a TP53 mutation in the adenocarcinoma component only, and a different pattern of retention and loss of heterozygosity. These findings imply that it is not possible to recognize true collision tumors from immunohistologic appearance alone and suggest that the long-standing histologic criteria for the diagnosis of these neoplasms have no molecular basis.
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Affiliation(s)
- Anya N A Milne
- Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands.
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35
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Zheng Q, Chen XY, Shi Y, Xiao SD. Development of gastric adenocarcinoma in Mongolian gerbils after long-term infection with Helicobacter pylori. J Gastroenterol Hepatol 2004; 19:1192-8. [PMID: 15377299 DOI: 10.1111/j.1440-1746.2004.03469.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM The experimental evidence that long-term colonization of Helicobacter pylori results in the development of gastric cancer in Mongolian gerbils has been reported only by two Japanese groups to date. This study aimed to investigate the carcinogenicity of H. pylori infection in a Mongolian gerbil model. METHODS Thirty-six Mongolian gerbils (inner Mongolian origin) were divided into two groups (male to female ratio, 1:1) and orally inoculated with a standard H. pylori strain (ATCC43504) or H. pylori161 (isolated from a Chinese patient with gastric adenocarcinoma), respectively, once a week for 5 weeks. Another 10 control gerbils were given phosphate-buffered saline. The animals were killed 8, 20, 28 and 84 weeks after inoculation for bacterial and histological examination. RESULTS Seven inoculated gerbils died at the week 42. Overall, H. pylori colonization was detected in 24 (83%) of the 29 available inoculated gerbils. The gastric lesions were aggravated gradually over time. At week 84, moderate to severe gastritis, characterized by diffuse infiltration of mononuclear cells and formation of multiple lymphoid follicles in mucosa and submucosa, and even the lymphoepithelial lesions, were observed. Epithelial hyperplasia were dominant in almost all gerbils. Four (24%) of the 17 animals had hyperplastic polyps. Intestinal metaplasia were rarely seen (in three gerbils). Well-differentiated gastric adenocarcinomas developed in three (18%) of the 17 gerbils after 84 weeks. Of the three gerbils, one female gerbil was infected with H. pylori161 and the others (one male and one female) were infected with ATCC43504. CONCLUSIONS The present study reconfirms that H. pylori infection alone can induce gastric adenocarcinoma in Mongolian gerbils and suggests that different species of gerbil and both standard and clinically isolated H. pylori strains can be used for investigating the carcinogenesis of H. pylori. This is the first report of the development of gastric cancer in female gerbils, which highlights the importance of using both sexes to investigate the pathogenesis of H. pylori and whether host susceptibility is influenced by sex.
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Affiliation(s)
- Qing Zheng
- Department of Gastroenterology, Renji Hospital, Shanghai Second Medical University, Shanghai Institute of Digestive Disease, Shanghai, China
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36
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Raderer M, Püspök A, Stummvoll G, Längle F, Chott A. Early cancer of the stomach arising after successful treatment of gastric MALT lymphoma in patients with autoimmune disease. Scand J Gastroenterol 2003; 38:294-7. [PMID: 12737445 DOI: 10.1080/00365520310000582] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Extranodal marginal zone B-cell lymphoma of the mucosa associated lymphoid tissue (MALT lymphoma) arises in lymphoid tissue acquired through chronic antigenic stimulation as exemplified by Helicobacter pylori. Secondary development of gastric cancer, however, is thought to be a rare event. The detection of a signet ring cell carcinoma during follow-up endoscopy after successful therapy of MALT lymphoma in a patient with Sjögren's syndrome prompted us to analyse the frequency of subsequent gastric cancer in patients with underlying autoimmune disease (AD). METHODS Patients with early stage MALT lymphoma and an underlying AD were evaluated for the occurrence of a secondary gastric cancer during the course of follow-up. Data analysed included the type of AD, stage of MALT lymphoma, H. pylori status, treatment for MALT lymphoma and response, follow-up, the presence of a secondary cancer, and time to development of cancer. In all patients, histologic samples were reassessed for the extent of gastritis, presence of intestinal metaplasia or focal atrophy at the time of lymphoma diagnosis. RESULTS A total of eight patients with overt AD at the time of diagnosis of MALT lymphoma were identified. All patients were women aged between 56 and 77 years; 5 had Sjögren's syndrome, 2 had autoimmune thyroiditis (1 along with psoriasis) and 1 suffered from polymyalgia rheumatica. All patients had early stage MALT lymphoma restricted to the mucosa and submucosa at the time of diagnosis, and the presence of H. pylori was found in all cases. Two of these patients achieved complete remission (CR) of the lymphoma following H. pylori eradication, while six were judged unresponsive and underwent chemotherapy, resulting in CR in all cases. One patient died from stroke while being in CR for 2 months following chemotherapy. Two patients (25%) developed early cancer limited to the gastric mucosa while being in CR from lymphoma for 9 and 27 months, respectively, and underwent partial gastrectomy. Final staging of gastric cancer revealed pT1pN0M0 in both cases. Of the remaining 5 cases, 1 patient had a local lymphoma relapse 18 months after CR and was salvaged with radiotherapy. In the remaining 4 patients, no evidence of lymphoma recurrence or a second malignancy has been found so far by regular follow-up every 3 months for a time-span between 52 and 63 months after initial diagnosis. CONCLUSION Patients with concurrent MALT lymphoma and an underlying autoimmune condition show not only an impaired response to H. pylori eradication but might also be at increased risk for the development of gastric cancer. In view of this, such patients should be followed closely by regular endoscopies after remission of MALT lymphoma.
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Affiliation(s)
- M Raderer
- Dept. of Internal Medicine I, Division of Oncology, University of Vienna, Austria.
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Kaffes A, Hughes L, Hollinshead J, Katelaris P. Synchronous primary adenocarcinoma, mucosa-associated lymphoid tissue lymphoma and a stromal tumor in a Helicobacter pylori-infected stomach. J Gastroenterol Hepatol 2002; 17:1033-6. [PMID: 12167128 DOI: 10.1046/j.1440-1746.2002.02649.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We report the case of a 78-year-old man with Helicobacter pylori infection and three primary neoplasms of the stomach: adenocarcinoma, mucosa-associated lymphoid tissue (MALT) lymphoma and a gastrointestinal stromal cell tumor. Helicobacter pylori infection is associated with gastric carcinoma and MALT lymphoma, although their simultaneous occurrence is rare. Gastrointestinal stromal cell tumors have not been associated with infection to date. This appears to be the first report of the synchronous occurrence of these three gastric tumors.
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Affiliation(s)
- Arthur Kaffes
- Department of Gastroenterology, The University of Sydney, Concord Hospital, New South Wales, Australia
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38
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Eguchi S, Matsuo S, Hidaka M, Azuma T, Yamaguchi S, Hayashi T, Eguchi S, Kanematsu T. Concomitant triple lesions of adenocarcinoma, malignant lymphoma, and granular cell tumor of the stomach. J Clin Gastroenterol 2002; 35:107-9. [PMID: 12080245 DOI: 10.1097/00004836-200207000-00031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Ghoshal UC, Guha D, Bandyopadhyay S, Pal C, Chakraborty S, Ghoshal U, Ghosh TK, Pal BB, Banerjee PK. Gastric adenocarcinoma in a patient re-infected with H. pylori after regression of MALT lymphoma with successful anti-H. pylori therapy and gastric resection: a case report. BMC Gastroenterol 2002; 2:6. [PMID: 11914140 PMCID: PMC102757 DOI: 10.1186/1471-230x-2-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2001] [Accepted: 03/14/2002] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Helicobacter pylori (H. pylori) has been etiologically linked with primary gastric lymphoma (PGL) and gastric carcinoma (GC). There are a few reports of occurrence of both diseases in the same patients with H. pylori infection. CASE PRESENTATION We report a patient with PGL in whom the tumor regressed after surgical resection combined with eradication of H. pylori infection. However, he developed GC on follow up; this was temporally associated with recrudescence/re-infection of H. pylori. This is perhaps first report of such occurrence. CONCLUSIONS Possible cause and effect relationship between H. pylori infection and both PGL and GC is discussed. This case also documents a unique problem in management of PGL in tropical countries where re-infection with H. pylori is supposed to be high.
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Affiliation(s)
- Uday C Ghoshal
- Department of Gastroenterology, Seth Sukhlal Karnani Memorial Hospital & Institute of Postgraduate Medical Education and Research, 244, AJC Bose Road, Kolkata 700020, India
| | - Debashish Guha
- Department of Pathology, Seth Sukhlal Karnani Memorial Hospital & Institute of Postgraduate Medical Education and Research, 244, AJC Bose Road, Kolkata 700020, India
| | - Santu Bandyopadhyay
- Department of Cellular Immunology, Indian Institute of Chemical Biology, Kolkata, India
| | - Chiranjib Pal
- Department of Cellular Immunology, Indian Institute of Chemical Biology, Kolkata, India
| | | | - Ujjala Ghoshal
- Department of Microbiology, NRS Medical College, Kolkata, India
| | - Tamal K Ghosh
- Science and Instrument center, Burdwan University, Burdwan, India
| | - Bhaskar B Pal
- Department of Gastroenterology, Seth Sukhlal Karnani Memorial Hospital & Institute of Postgraduate Medical Education and Research, 244, AJC Bose Road, Kolkata 700020, India
| | - Prabir K Banerjee
- Department of Gastroenterology, Seth Sukhlal Karnani Memorial Hospital & Institute of Postgraduate Medical Education and Research, 244, AJC Bose Road, Kolkata 700020, India
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40
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Bégueret H, Vergier B, Parrens M, Lehours P, Laurent F, Vernejoux JM, Dubus P, Velly JF, Mégraud F, Taytard A, Merlio JP, de Mascarel A. Primary Lung Small B-Cell Lymphoma versus Lymphoid Hyperplasia: Evaluation of Diagnostic Criteria in 26 Cases. Am J Surg Pathol 2002; 26:76-81. [PMID: 11756772 DOI: 10.1097/00000478-200201000-00009] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Primary lung non-Hodgkin's lymphoma is a rare neoplasm mostly represented by low-grade B-cell lymphomas of mucosa-associated lymphoid tissue. Their diagnostic criteria are now well defined on surgical specimens, but pathologists may experience difficulties in distinguishing them on exiguous biopsies from benign lymphoid hyperplasia and other lymphomas. Therefore, we examined a series of 26 lung lymphoid lesions to further define the pathologic features of either lymphoma or lymphoid hyperplasia on small specimens. We observed 16 primary lung non-Hodgkin's lymphomas with a large predominance of low-grade mucosa-associated lymphoid tissue-type lymphomas (87.5%, n = 14). There were no autoimmune disorders, but three patients had a concomitant infectious disease (hepatitis C virus and Helicobacter pylori gastritis). One patient presented with a synchronous pulmonary adenocarcinoma. As well as the classical mucosa-associated lymphoid tissue cellular infiltrate, immunohistochemical characterization of the 14 mucosa-associated lymphoid tissue-type lymphomas revealed the CD20+/CD43+ centrocyte-like cell phenotype in 10 cases (71.5%). Although the lymphoepithelial lesions observed in all lymphomatous cases have been reported in lung lymphoid hyperplasia, the determination of B-cell CD20+/CD43+ phenotype of the intraepithelial lymphocytes highly increased the specificity of lymphoepithelial lesions. A monoclonal immunoglobulin heavy chain gene rearrangement was present in 71.4% of the mucosa-associated lymphoid tissue-type lymphoma specimens. Investigation of H. pylori by polymerase chain reaction detection was negative, even for the two cases associated with H. pylori gastritis.
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Affiliation(s)
- Hugues Bégueret
- Department of Pathology and Molecular Biology, Université de Bordeaux, Bordeaux, France.
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Chan AO, Chu KM, Yuen ST, Leung SY, Lam SK, Wong J. Synchronous gastric adenocarcinoma and mucosa-associated lymphoid tissue lymphoma in association with Helicobacter pylori infection: comparing reported cases between the East and West. Am J Gastroenterol 2001; 96:1922-4. [PMID: 11419851 DOI: 10.1111/j.1572-0241.2001.03895.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The association of Helicobacter pylori infection with synchronous gastric adenocarcinoma and mucosa-associated lymphoid tissue (MALT) lymphoma is rare. Three Chinese patients (M:F = 1:2) who were 71, 58, and 75 yr of age were diagnosed to have gastric adenocarcinoma (2 patients) and gastric lymphoma (1 patient) on endoscopic biopsies. Distal gastrectomy was performed in all of them. Histological study of the three resected specimens revealed synchronous gastric adenocarcinoma and MALT lymphoma. H. pylori infection was found in two patients. A literature search revealed another 29 patients with synchronous tumors in whom H. pylori status was examined. Overall, H. pylori infection was found in 78% of 32 patients. The majority of lymphoma was low grade (75%) and was larger than carcinoma (81%). The majority of carcinoma (65.6%) was early. This suggested lymphoma might develop before carcinoma or the presence of MALT lymphoma might increase the risk of developing carcinoma.
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Affiliation(s)
- A O Chan
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, China
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42
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Arista-Nasr J, Jiménez-Rosas F, Uribe-Uribe N, Herrera-Goepfert R, Lazos-Ochoa M. Pathological disorders of the gastric mucosa surrounding carcinomas and primary lymphomas. Am J Gastroenterol 2001; 96:1746-50. [PMID: 11419824 DOI: 10.1111/j.1572-0241.2001.03868.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Gastritis, intestinal metaplasia, atrophy, and dysplasia are disorders that frequently precede the full development of gastric adenocarcinoma. On the other hand, primary gastric lymphomas seem to arise from mucosa-associated lymphoid tissue. It is well accepted that these histological changes are caused by Helicobacter pylori infection. The objective of this study is to determine the frequency and characteristics of epithelial and lymphoid tissue disorders of the gastric mucosa surrounding primary carcinomas and lymphomas. METHODS We studied 111 gastrectomies from patients harboring primary adenocarcinomas (30 intestinal and 30 diffuse type) and 51 gastric lymphomas. For comparative purposes, we analized 86 stomachs from patients who died of diseases other than gastric malignancies. Histopathological disorders of the gastric mucosa adjacent to primary neoplasms such as atrophy, intestinal metaplasia, and dysplasia were recorded. Lymphoid follicles were classified in two groups, with or without expansion. Expansion was characterized by increased size, irregular borders, enlarged marginal zone, and expanded germinal centers. Differences were statistically evaluated with chi2 and Fisher exact tests, odds ratio, and relative risk, with 95% CI. p values <0.05 were considered statistically significant. RESULTS Most intestinal-type adenocarcinomas showed atrophy (76.6%) and intestinal metaplasia (86.6%) and less frequently, dysplasia (23.3%), in the surrounding gastric mucosa. Expansive lymphoid follicles were more frequent among lymphomas than in adenocarcinomas (56.8% vs 25%); however, a high percentage of lymphomas were also associated with atrophy (50.9%), intestinal metaplasia (62.7%), and rarely dysplasia (11.8%). On the contrary, diffuse-type adenocarcinoma displayed less frequently atrophy (33%), intestinal metaplasia (50%), and dysplasia (3%). Gastric mucosa from patients without any gastric neoplasia was almost normal (84%), whereas the remaining 16% showed, both or alone, atrophy and intestinal metaplasia. CONCLUSION Histopathological disorders of the gastric mucosa are not specific for any neoplasm, but intestinal-type adenocarcinomas frequently showed atrophy, intestinal metaplasia, and not uncommonly, dysplasia of the surrounding non-neoplastic gastric mucosa. Diffuse-type adenocarcinomas did not frequently show such lesions. Primary lymphomas displayed expansive lymphoid follicles and also a high percentage of atrophy and intestinal metaplasia of the surrounding gastric mucosa. The presence of intestinal metaplasia, atrophy, and lymphoid follicles with expansion in endoscopic biopsies could suggest a higher suceptibility for the development of gastric intestinal-type adenocarcinoma or gastric lymphoma. Patients harboring such histopathological changes must receive eradication therapy against H. pylori and probably closer follow-up.
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Affiliation(s)
- J Arista-Nasr
- Department of Pathology, Instituto Nacional de la Nutrición Salvador Zubirán, México DF, Mexico
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43
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Morgner A, Miehlke S, Stolte M, Neubauer A, Alpen B, Thiede C, Klann H, Hierlmeier FX, Ell C, Ehninger G, Bayerdörffer E. Development of early gastric cancer 4 and 5 years after complete remission of Helicobacter pylori associated gastric low grade marginal zone B cell lymphoma of MALT type. World J Gastroenterol 2001; 7:248-53. [PMID: 11819769 PMCID: PMC4723531 DOI: 10.3748/wjg.v7.i2.248] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To report 3 of 120 patients on the German MALT lymphoma trial with H. pylori associated gastric MALT lymphoma who developed early gastric cancer 4 and 5 years, after complete lymphoma remission following cure of H. pylori infection.
PATIENTS AND RESULTS: Three patients (two men, 74 and 70 years; one women, 77 years) with H. pylori-associated low-grade MALT lymphoma achieved complete lymphoma remission after being cured. Surveillance endoscopies were performed twice a year in accordance to the protocol. Four years after complete lymphoma remission in two patients, and after 5 years in the other, early gastric adenocarcinoma of the mucosa-type, type II a and type II c, respectively, was detetcted, which were completely removed by endoscopic mucosa resection. In one patient, the gastric cancer was diagnosed at the same location as the previous MALT lymphoma, in the other patients it was detected at different sites of the stomach distant from location of the previous MALT lymphoma. The patients were H. pylori negative during the whole follow-up time.
CONCLUSION: These findings strengthen the importance of regular Long term follow-up endoscopies in patients with complete remission of gastric MALT lymphoma after cure of H. pylori infection. Furthermore, gastric adenocarcinoma may develop despite eradication of H. pylori.
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Affiliation(s)
- A Morgner
- Medical Department I, Technical University Hospital, Fetscherstr.74, 01307 Dresden, Germany.
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44
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Chanel S, Burke L, Fiche M, Molina T, Lerochais JP, Icard P, Diebold J, Galateau-Sallé F. Synchronous pulmonary adenocarcinoma and extranodal marginal zone/low-grade B-cell lymphoma of MALT type. Hum Pathol 2001; 32:129-32. [PMID: 11172307 DOI: 10.1053/hupa.2001.20893] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A case of synchronous adenocarcinoma of lung and extranodal marginal zone/low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) is reported. Primary pulmonary non-Hodgkin's lymphoma is relatively rare, however, the majority of these lesions are low-grade B-cell lymphomas of MALT. After the stomach, the lung is the second most common location for such latter lesions. Lung adenocarcinoma in selected countries is fast becoming the leading form of non small-cell lung carcinoma. To our knowledge, this synchronous occurrence in the lung has not been previously reported. Such associations have been primarily limited to gastric lesions where an association with Helicobacter pylori infection has been identified. This case report highlights the importance of adjunctive diagnostic investigations such as molecular techniques in conclusive analysis of synchronous cases such as ours.
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MESH Headings
- Adenocarcinoma/genetics
- Adenocarcinoma/metabolism
- Adenocarcinoma/pathology
- Aged
- Antigens, CD20/analysis
- DNA, Neoplasm/genetics
- Gene Rearrangement, B-Lymphocyte, Heavy Chain/genetics
- Humans
- Immunohistochemistry
- Lung Neoplasms/genetics
- Lung Neoplasms/metabolism
- Lung Neoplasms/pathology
- Lymphoma, B-Cell, Marginal Zone/genetics
- Lymphoma, B-Cell, Marginal Zone/metabolism
- Lymphoma, B-Cell, Marginal Zone/pathology
- Male
- Polymerase Chain Reaction
- Proto-Oncogene Proteins c-bcl-2/analysis
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Affiliation(s)
- S Chanel
- Department of Anatomic Pathology, CHU Caen Cote de Nacre, Caen, France
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45
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Arista-Nasr J, Herrera-Goepfert R, Lazos-Ochoa M, Pichardo R. Histologic changes of the gastric mucosa associated with primary gastric lymphoma in endoscopic biopsy specimens. Arch Pathol Lab Med 2000; 124:1628-31. [PMID: 11079014 DOI: 10.5858/2000-124-1628-hcotgm] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Recently, we have observed intestinal metaplasia, atrophy, and dysplasia in the mucosa adjacent to primary gastric lymphoma (PGL) in gastrectomy specimens. OBJECTIVE To determine the frequency and type of epithelial disorders at the histopathologic level in the mucosa adjacent to PGL in endoscopic specimens. DESIGN We studied 54 endoscopic biopsies from patients harboring PGL. We searched for the following morphologic changes in the gastric mucosa: intestinal metaplasia; atrophy; dysplasia; epithelial erosion; and atypical regeneration of the glandular epithelium. Other nonepithelial findings such as lymphoid follicles, Helicobacter pylori, and lymphoma grade, were also recorded. For comparative purposes, 50 endoscopic biopsies with gastric adenocarcinoma and 50 biopsies with chronic gastritis associated with H pylori infection were also studied. RESULTS The 54 biopsies included 28 (52%) low-grade and 26 (48%) high-grade PGLs. We found intestinal metaplasia in 32 biopsies (59%), atrophy in 20 biopsies (37%), dysplasia in 2 biopsies (4%), erosion of the epithelium in 33 biopsies (61%), and atypical regenerative changes of the glandular epithelium in 10 biopsies (19%). Lymphoid follicles were found in 21 biopsies (39%), and H pylori was demonstrated in 31 biopsies (57%). When groups were compared, the frequency of epithelial changes in biopsies from patients with PGL and adenocarcinoma was similar. Intestinal metaplasia or atrophy were present in only 10% of biopsies from patients with gastritis, and dysplastic glands were not identified. CONCLUSIONS Biopsies from patients with PGL showed chronic damage of the gastric mucosa at diagnosis, including precancerous conditions. Intestinal metaplasia and atrophy were among the most frequent disorders, but dysplasia was also occasionally present. Endoscopists and pathologists must be acquainted with such changes and look for them in the initial biopsy, as well in subsequent samples. This practice is particularly important when reviewing biopsies from patients with low-grade mucosa-associated lymphoid tissue (MALT)-lymphomas who are eligible for eradication treatment for H pylori.
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Affiliation(s)
- J Arista-Nasr
- Department of Pathology, Instituto Nacional de la Nutrición Salvador Zubirán, México, D.F., Mexico.
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46
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Maiorana A, Fante R, Maria Cesinaro A, Adriana Fano R. Synchronous occurrence of epithelial and stromal tumors in the stomach: a report of 6 cases. Arch Pathol Lab Med 2000; 124:682-6. [PMID: 10782147 DOI: 10.5858/2000-124-0682-sooeas] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The synchronous development of epithelial and stromal tumors in the stomach has been reported rarely in the literature. A series of 6 such cases is described in this article. METHODS Clinical and pathologic data were recorded and the literature was reviewed. RESULTS Five cases featured the simultaneous occurrence of stromal tumors (1 benign, 3 borderline, 1 malignant) and adenocarcinomas, whereas the stromal tumor in the sixth case was found in association with a carcinoid. No collision tumors were observed. In 2 cases, tumors arose from the same site and were closely juxtaposed, but in 4 patients they developed from different areas of the stomach. A preoperative histologic diagnosis of both tumors was not achieved in any case. Two patients harbored occult infiltrative epithelial lesions (1 diffuse-type adenocarcinoma, 1 carcinoid), which were detected only at pathologic examination of the gastric mucosa adjacent to the stromal tumor. CONCLUSIONS The simultaneous occurrence of epithelial and stromal tumors in the stomach can be less rare than usually expected. Coincidence alone could account for such an association, particularly in areas with high incidence rates of gastric cancer. The hypothesis that a single carcinogenic agent might interact with two neighboring tissues in the stomach inducing the development of tumors of different histotype cannot be theoretically discarded.
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Affiliation(s)
- A Maiorana
- Sezione di Anatomia Patologica, Dipartimento di Scienze Morfologiche e Medico-Legali, University of Modena, Modena, Italy
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Pakodi F, Abdel-Salam OM, Debreceni A, Mózsik G. Helicobacter pylori. One bacterium and a broad spectrum of human disease! An overview. JOURNAL OF PHYSIOLOGY, PARIS 2000; 94:139-52. [PMID: 10791696 DOI: 10.1016/s0928-4257(00)00160-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Since the historical rediscovery of gastric spiral Helicobacter pylori in the gastric mucosa of patients with chronic gastritis by Warren and Marshall in 1983, peptic ulcer disease has been largely viewed as being of infectious aetiology. Indeed, there is a strong association between the presence of H. pylori and chronic active gastritis in histology. The bacterium can be isolated in not less than 70% of gastric and in over 90% of duodenal ulcer patients. Eradication of the organism has been associated with histologic improvement of gastritis, lower relapse rate and less risk of bleeding from duodenal ulcer. The bacterium possesses several virulence factors enabling it to survive the strong acid milieu inside the stomach and possibly damaging host tissues. The sequence of events by which the bacterium might cause gastric or duodenal ulcer is still not fully elucidated and Koch's postulates have never been fulfilled. In the majority of individuals, H. pylori infection is largely or entirely asymptomatic and there is no convincing data to suggest an increase in the prevalence of peptic ulcer disease among these subjects. An increasingly growing body of literature suggests an association between colonization by H. pylori in the stomach and a risk for developing gastric mucosa-associated lymphoid tissue (MALT), MALT lymphoma, gastric adenocarcinoma and even pancreatic adenocarcinoma. The bacterium has been implicated also in a number of extra-gastrointestinal disorders such as ischaemic heart disease, ischaemic cerebrovascular disease, atherosclerosis, and skin diseases such as rosacea, but a causal role for the bacterium is missing. Eradication of H. pylori thus seems to be a beneficial impact on human health. Various drug regimens are in use to eradicate H. pylori involving the administration of three or four drugs including bismuth compounds, metronidazole, clarithromycin, tetracyclines, amoxycillin, ranitidine, omeprazole for 1-2 weeks. The financial burden, side effects and emergence of drug resistant strains due to an increase in the use in antibiotics for H. pylori eradication therapy need further reconsideration.
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Affiliation(s)
- F Pakodi
- First Department of Medicine, Medical University of Pécs, Hungary
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48
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Ioachim HL, Hajdu C, Giancotti FR, Dorsett B. Lymphoid proliferations and lymphomas associated with gastric metaplasia, dysplasia, and carcinoma. Hum Pathol 1999; 30:833-42. [PMID: 10414503 DOI: 10.1016/s0046-8177(99)90145-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Gastric carcinomas are invariably accompanied by lymphoid proliferations. We studied their features in 22 resected gastric carcinomas in which the lymphoid proliferations ranged from reactive lymphoid follicles to mucosa-associated lymphoid tissue (MALT) lymphomas. In most cases, the collections of lymphocytes were abundant, which is remarkable considering the lack of lymphoid tissue in the normal stomach. They were not haphazardly located but in direct contact with the metaplastic, dysplastic, and neoplastic epithelial cells, in positions suggestive of defense barriers. They consisted of newly formed lymphoid follicles with reactive germinal centers sometimes high up in the superficial mucosa, collections of plasma cells beneath the surface epithelium, and large aggregates of B cells above and below the muscularis mucosae as well as abundant T cells. The latter, both CD4+ and CD8+, were seen within metaplastic epithelial cells as well as within carcinomatous glands that were partially destroyed, resembling apparent neoplastic lympho-epithelial lesions (LEL). In three cases, the B cells infiltrating the gastric muscular layers represented MALT-lymphomas adjacent to gastric carcinomas, as confirmed by polymerase chain reaction (PCR) analysis in two cases. In a case of lymphoepithelioma-like carcinoma, the excessive lymphoid cells were predominantly of T-CD8+ type. In this case, EBV identified by EBV-encoded RNA and latent membrane protein was present in large amounts. Helicobacter pylori was seen in only six cases in areas of chronic gastritis that were distant from carcinoma. H. pylori was not present in the areas of metaplasia, dysplasia, or carcinoma. It appears that the lymphoid proliferations accompanying these gastric changes do not arise in response to the pathogenic agent H. pylori, which caused the persistent infection leading to them yet is no longer present, but rather in response to the existence of the abnormal epithelial cells. Thus the lymphoid proliferations consistently associated with gastric metaplasia, dysplasia, and neoplasia may be regarded as immune reactions to the long-term cellular changes triggered by the initial chronic gastritis. On rare occasions, the exaggerated lymphoid proliferations may reach the end of the spectrum, resulting in MALT lymphomas coexistent with gastric carcinomas.
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Affiliation(s)
- H L Ioachim
- Department of Pathology of Lenox Hill Hospital, New York University, NY 10021, USA
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Au WY, Gascoyne RD, Le N, Viswanatha DS, Klasa RJ, Gallagher R, Connors JM. Incidence of second neoplasms in patients with MALT lymphoma: no increase in risk above the background population. Ann Oncol 1999; 10:317-21. [PMID: 10355576 DOI: 10.1023/a:1008328226599] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Lymphomas of mucosa associated lymphoid tissue (MALT) are a special type of extranodal lymphoma, possibly related to chronic antigenic stimulation. Increased cancer susceptibility may also contribute to the development of MALT lymphoma (MALToma). It has been suggested that patients with MALToma have an increased incidence of other malignancies. PATIENTS AND METHODS We retrospectively reviewed the histology and clinical records of 147 patients with MALToma, including 51 cases of gastric MALToma. The incidence of any second malignancy was confirmed with a provincial registry. The relative rates of cancer, excluding MALToma, were calculated relative to the background population of the same age group and secular year. RESULTS A total of 41 tumors occurred in 32 patients (21%), including 22 solid tumors. The incidence of solid tumors in the gastric MALToma group was 15%. Seven patients had two or more second malignancies. Cancer occurred before diagnosis of MALToma in 29 cases, concurrent with MALToma in three, and after MALToma in nine. Follow-up of the surviving patients is short (median 17.6 months). The relative rate from birth of a second malignancy was 0.86 in the whole group (90% confidence interval (CI): 0.62-1.16) and 0.95 (90% CI: 0.55-1.54) in the gastric MALToma group. The rates were roughly the same if skin cancers were excluded. CONCLUSIONS The incidence of second cancers in this series is similar to previous reports. However, when compared to an age-matched population followed for the same period of time, MALToma patients do not appear to have a statistically significant increased rate of cancers.
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MESH Headings
- Adult
- Age Distribution
- Aged
- Aged, 80 and over
- British Columbia/epidemiology
- Combined Modality Therapy
- Female
- Humans
- Incidence
- Lymphoma, B-Cell, Marginal Zone/diagnosis
- Lymphoma, B-Cell, Marginal Zone/epidemiology
- Lymphoma, B-Cell, Marginal Zone/therapy
- Male
- Middle Aged
- Neoplasms, Second Primary/diagnosis
- Neoplasms, Second Primary/epidemiology
- Neoplasms, Second Primary/therapy
- Prognosis
- Retrospective Studies
- Risk Factors
- Sex Distribution
- Skin Neoplasms/epidemiology
- Stomach Neoplasms/epidemiology
- Survival Rate
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Affiliation(s)
- W Y Au
- Division of Medical Oncology, British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada
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50
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Kajimura M, Ootake M, Nakagawara M, Nagasawa M, Yoshida KI, Kataoka H, Shirai N, Shimizu SI, Kobayashi H, Nagata H, Nakaya Y. Low Grade MALToma and Early Cancer of the Stomach in a Patient with Helicobacter pylori Infection: A Case Report. Dig Endosc 1998; 10:318-322. [PMID: 30650921 DOI: 10.1111/j.1443-1661.1998.tb00576.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/1998] [Accepted: 07/27/1998] [Indexed: 02/08/2023]
Abstract
A causal relationship has been suggested between Helicobacter pylori infection and gastric malignancy, including both gastric cancer and low grade lymphoma of mucosa-associated lymphoid tissue (MALToma). We describe a rare case of simultaneous occurrence of low grade MALToma and early cancer of the stomach in a 72-year-old woman. In this patient, low grade MALToma not only had preceded gastric cancer by 5 years, but had also disappeared, and subsequently reappeared coexisting with early cancer of the stomach and Helicobacter pylori infection. Eradication therapy for Helicobacter pylori was performed immediately prior to subtotal gastrectomy for early gastric cancer of the pyloric area. Thereafter, regression of MALToma was observed. These results, taken together with a previously reported case of low grade MALToma, suggest that low grade MALToma of the stomach may fluctuate, at least in the initial stages, even in the presence of constant Helicobacter pylori infection.
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Affiliation(s)
- Masayoshi Kajimura
- Department of Gastroenterology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | | | | | | | | | | | | | - Shin-Ichi Shimizu
- Department of Pathology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | | | - Hitoshi Nagata
- Department of Surgery, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
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