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      Synchronous Adenocarcinoma and Mantle Cell Lymphoma of the Stomach

      case-report
      Author(s): ,
      Publication date (Electronic):
      Journal: Yonsei Medical Journal
      Publisher: Yonsei University College of Medicine
      Keywords: Synchronous, adenocarcinoma, mantle cell lymphoma

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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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          Most cited references25

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          A revised European-American classification of lymphoid neoplasms: a proposal from the International Lymphoma Study Group.

          N Harris, E S Jaffe, H. Stein … (1994)
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            A clinical evaluation of the International Lymphoma Study Group classification of non-Hodgkin's lymphoma. The Non-Hodgkin's Lymphoma Classification Project.

            W.C. Chan, F. Cavalli, P Jacobs … (1997)
            The recognition of several new types of non-Hodgkin's lymphoma (NHL) in recent years has led to proposals for changing lymphoma classifications, including a new proposal put forth by the International Lymphoma Study Group (ILSG). However, the clinical significance of the new entities and the practical utility of this new proposal have not been studied. Therefore, we performed a clinical evaluation of the ILSG classification. A cohort of 1,403 cases of NHL was organized at nine study sites around the world and consisted of consecutive patients seen between 1988 and 1990 who were previously untreated. A detailed protocol for histologic and clinical analysis was followed at each site, and immunologic characterization as to T- or B-cell phenotype was required. Five expert hematopathologists visited the sites and each classified each case using the ILSG classification. A consensus diagnosis was also reached in each case, and each expert rereviewed a 20% random sample of the cases. Clinical correlations and survival analyses were then performed. A diagnosis of NHL was confirmed in 1,378 (98.2%) of the cases. The most common lymphoma types were diffuse large B-cell lymphoma (31%) and follicular lymphoma (22%), whereas the new entities comprised 21% of the cases. Diagnostic accuracy was at least 85% for most of the major lymphoma types, and reproducibility of the diagnosis was 85%. Immunophenotyping improved the diagnostic accuracy by 10% to 45% for a number of the major types. The clinical features of the new entities were distinctive. Both the histologic types and the patient characteristics as defined by the International Prognostic Index predicted for patient survival. In conclusion we found that the ILSG classification can be readily applied and identifies clinically distinctive types of NHL. However, for clinical application, prognostic factors as defined by the International Prognostic Index must be combined with the histologic diagnosis for appropriate clinical decisions.
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              Frequency of gastrointestinal involvement and its clinical significance in mantle cell lymphoma.

              Anas Younes, Nicola J M Brown, Luis Fayad … (2003)
              The reported frequency of gastrointestinal (GI) tract involvement in patients with mantle cell lymphoma (MCL) is 15-30%. However, this figure most likely is an underestimate because most patients with MCL involving the GI tract previously reported were examined endoscopically only if they had GI tract symptoms. The impact of endoscopic assessment on the management of MCL patients is unknown. From March 1998 to May 2001 baseline upper and lower endoscopy of the GI tract was performed in consecutive untreated patients with MCL as part of a prospective therapeutic trial. Biopsies were performed on abnormal as well as macroscopically normal mucosa. Endoscopy was repeated during treatment and as part of follow-up evaluations. Only 26% of patients presented with GI symptoms at the time of diagnosis. MCL was present histologically in the lower GI tract of 53 of 60 patient (88%) and in the upper GI tract of 28 of 58 patients (43%). Microscopic evidence of MCL was found in 84% of patients with normal visual (macroscopic) findings by lower endoscopy and in 45% of patients with macroscopically normal findings by upper endoscopy. Despite this high frequency of GI tract involvement, the use of upper and lower endoscopy with biopsies in this group of patients resulted in changes in clinical management in only three (4%) patients. Gastrointestinal tract involvement was found to be present in most patients with MCL, usually at a microscopic level involving macroscopically normal mucosa. The use of aggressive staging evaluation of the GI tract was found to have little impact on patient management decisions in the current study. Copyright 2003 American Cancer Society.DOI 10.1002/cncr.11096
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                Author and article information

                Journal
                Journal ID (nlm-ta): Yonsei Med J
                Journal ID (publisher-id): YMJ
                Title: Yonsei Medical Journal
                Publisher: Yonsei University College of Medicine
                ISSN (Print): 0513-5796
                ISSN (Electronic): 1976-2437
                Publication date (Print): 31 December 2007
                Publication date (Electronic): 31 December 2007
                Volume: 48
                Issue: 6
                Pages: 1061-1065
                Affiliations
                Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea.
                Author notes
                Reprint address: requests to Dr. Yong Il Kim, Department of Surgery, Ewha Womans University College of Medicine, 70 Chongro-6ga, Chongro-gu, Seoul 110-787, Korea. Tel: 82-2-760-5124, Fax: 82-2-743-7297, kimyi@ 123456ewha.ac.kr
                Article
                DOI: 10.3349/ymj.2007.48.6.1061
                PMC ID: 2628182
                PubMed ID: 18159604
                SO-VID: a4b1eefb-f040-4ec3-a924-8d20a041b7d3
                Copyright © Copyright © 2007 The Yonsei University College of Medicine
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 18 July 2006
                Date accepted : 14 November 2006
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Medicine
                Keywords: mantle cell lymphoma,adenocarcinoma,synchronous
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: mantle cell lymphoma, adenocarcinoma, synchronous

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