Malignant lymphoma occurring in the residual stomach following gastrectomy: plus discussion based on the literature in Japan

Abstract

A 53-year-old man was examined because of mild anemia (hemoglobin [Hb], 11.6g/dl) in August 1996. He had undergone pyloric gastrectomy with Billroth-I reconstruction for perforated benign gastric ulcer in 1988. Gastric transillumination and endoscopy showed comparatively soft, giant fold-like protruding lesions spreading over the entire residual stomach, and biopsy revealed the lesions to be malignant lymphoma. X-Rays of the large intestine and colonoscopy with biopsy demonstrated Borrmann type 2 highly differentiated adenocarcinoma in the upper rectum. At laparotomy in November 1996, a tumor was observed throughout the residual stomach. Lymph nodes were enlarged around the stomach and along the common hepatic artery and splenic artery and in the hepatoduodenal ligament. Total gastrectomy with splenectomy and purging of the lymph nodes was performed, in addition to a lower anterior resection of the rectum for the rectal cancer. The surgical specimen, which consisted of a 12 ϫ 9-cm gastric stump, showed giant fold-like protruding lesions occupying the entire residual stomach (Fig. 1). Histological examinations revealed large lymphocyte-like cells with a round or cleaved nucleus infiltrating across the proper muscle layer from the mucous membrane of the stomach wall. Similar cellular infiltration was also observed for lymph nodes nos. 1, 2, 3, 4sb, 8a, 10, 11, 12, and 272 (lymph nodes along the iliac artery). According to the results of immunohistological studies, the tumor was positive for B-cell markers, i.e., CD20 and CD45RA, and negative for T-cell markers, i.e., CD3 and CD45RO. In addition, both heavy-chain immunoglobulin IgM and light-chain k were strongly and monoclonally positive. These features were diagnostic of B-cell lymphoma of the diffuse, large-cell type. Helicobacter pylori microorganisms were demonstrated at the luminal surface of the tumor. The histology of the rectal cancer was highly differentiated adenocarcinoma

Lymphome malin non hodgkinien sur moignon de gastrectomie: à propos d’un nouveau cas

“…Il semble que lorsque le lymphome gastrique se greffe sur un moignon de gastrectomie, il s'agit souvent d'un lymphome à grandes cellules B de haut grade de malignité [9][10][11][12][13][14]. Ce type de tumeurs, caractérisées par leur chimiosensibilité, sont traitées par une polychimiothérapie associant, en plus du rituximab, la doxorubicine, le cyclophosphamide, la vincristine et le prednisone et par une éradication systématique de l'HP [15].…”

“…Selon les cas rapportés dans la littérature du lymphome malin survenant sur gastrectomie, il semble que son pronostic soit fluctuant [9,10,[12][13][14].…”

Report of Two Cases of Gastric Cancer after Bariatric Surgery: Lymphoma of the Bypassed Stomach after Roux-en-Y Gastric Bypass and Gastrointestinal Stromal Tumor (GIST) after Vertical Banded Gastroplasty

“…4 Lymphomas have been described in the proximal gastric stump 5 to 43 years after partial gastrectomy, with 15 cases reported in the western literature and 27 cases in Japan. 5,6 The gastric stump and the distal gastric segment may share in common an increased exposure to duodenal reflux with accompanying mucosal inflammation. It has been suggested that lymphocyte infiltration associated with chronic inflammation of the mucosa could develop into lymphoma.…”

Risk of Upper Gastrointestinal Cancer after Bariatric Operations

“…Lymphomas have been described in the proximal gastric stump 5 to 43 years after partial gastrectomy, with 15 cases reported in the Western literature and 27 cases in Japan. 25,26 The proximal gastric stump after the partial gastrectomy and the distal gastric remnant after RYGBP may share in common an increased exposure to duodenal reflux with accompanying mucosal inflammation. It has been suggested that lymphocyte infiltration associated with chronic inflammation of the mucosa could develop into lymphoma.…”