Paper # 001 Versión en Español Versión en Español

Adenocarcinoma of the Stomach after Therapy for Lymph Nodes Low Grade Lymphoma

Marcial Garcia-Rojo, Jesús González, Ana Morillo, Jesús Martín

[Title] [Introduction] [Results] [Pictures] [Discussion] [Bibliography]

Introduction

Results


MATERIALS & METHODS

We describe a 72 years old man that came into hospital suffering from asthenia and a 7 Kilograms weight loss. In his personal history, he suffered CT-Scanfrom spondylo-osteoarthritis and a prostatectomy for a benign prostate hyperplasia. At that time he has a good general status, without fever and with a normal pulmonary and cardiac examination. He was discovered to have multiple adenopathies in neck, axilla and inguinal regions, the biggest one was of 3 cm. In laboratory tests, no significant alterations were found. Hemoglobin as 13 g/dl and leukocytes count was 10.500 per microliter with 29.9 % segmented and 60.7% of lymphocytes. CT-Scan showed multiple adenopathies in mediastinum, retroperitoneum, mesenterium and around iliac and femoral vessels bilaterally.

A biopsy was performed from an adenopathy of the axillary region. The histopathological examination showed it was a low grade B-cell non Hodgkin lymphoma type lymphoplasmacytoid (immunocytoma).


A few days later of the diagnosis of lymphoma he was started on CVP (Cyclophosphamide 600 mg per day, Vincristine 1.5 mg per square meter in bolus and Prednisone 90 mg per day) for five days. Allopurinol and gastric protection were also prescribed.
After five cycles of chemotherapy the response to these agents was poor. Peripheral blood study after the last cycle was: leukocytes 8100 per microliter with 29.1% segmented and 53.3 % of lymphocytes. Hemoglobin was 13.6 g/dl.

Rx StomachSix months after the diagnosis of lymphoma the patient began with epigastric pain, pyrosis and vomiting of increasing intensity. A gastroduodenal radiological study was performed and it showed an stenosis and lack of distention at fundic area, with an irregular pattern of the mucosa, suggesting an malignant process. Gastric endoscopy revealed an normal esophagus, with a rigid gastric fundic area showing enlarged and irregular foldings of the mucosa that reached the antrum, bleeding very easily. Pylorus and Duodenum were normal. Several biopsies were taken from fundic area and antrum.
The histopathological studies of the gastric biopsies revealed the presence of a gastric signet ring adenocarcinoma.
At that time a new CT scan study showed the persistence of all the adenopathies found in the first study. No hepatic or pulmonary metastases were found.


A total gastrectomy and splenectomy were performed. At the time of surgery, multiple adenopathies were noted in the proximity of the head of the pancreas and in the lesser omentum and gastrocolic omentum. No hepatic metastases were noted. No postoperative complication presented.

Pathological procedures

Lymph node specimens were fixed in B5 solution. The rest of the specimens were fixed in buffered 10% formalin. Paraffin-embedded tissue sections were stained immunohistochemically by the streptavidin-biotine-alkaline phosphatase method with antibodies Common Leukocyte Antigen (CLA, Biomeda), CD-20 (L-26, Biomeda), CD45R0 (UCHL-1, Biogenex), Kappa light chain (Kappa, Biomeda), Lambda light chain (Lambda, Biomeda), keratin (CK8, 18 & 19, Biogenex) and Common Epithelial Antigen (CEA, Biomeda). The staining method for keratin required pretreatment with enzymes and microwave heating. 


Introduction

Results