Synchronous and metachronous primary gastric lymphoma and adenocarcinoma : A clinicopathologic study of 12 patients

✍ Scribed by N. Peter Zauber; Errol L. Berman

• Publisher: John Wiley and Sons
• Year: 1998
• Tongue: English
• Weight: 46 KB
• Volume: 82
• Category: Article
• ISSN: 0008-543X
• DOI: 10.1002/(sici)1097-0142(19980101)82:1<226::aid-cncr28>3.0.co;2-3

✦ Synopsis

nous and metachronous primary gastric lymphoma and adenocarcinoma. They reported only two cases of metachronous tumors, both with adenocarcinoma preceding the lymphoma. They referenced 18 previously reported metachronous cases, all with lymphoma preceding the adenocarcinoma.

We have seen one additional case of metachronous tumors. In 1985, a 78-year-old female was found to have a primary gastric lymphoma of large cleaved cell type. After a partial gastrectomy, she received 45 gray of radiation to the gastric area followed by 9 courses of intravenous cyclophosphamide over 10 months. In 1989 further gastrectomy was performed for an intestinal type adenocarcinoma of Grade 2 (World Health Organization) with moderate differentiation localized at the anastomotic line. In February 1997, gastroscopy revealed a small residual pouch of normal gastric mucosa and a normal anastomotic small intestine. Immunohistochemical stains of the original lymphoma and gastric tissue for Helicobacter pylori were negative. The adenocarcinoma tissue revealed no Ki-ras mutations in codons 12/13.

Factors contributing to the subsequent development of ''stump'' adenocarcinoma in a gastric remnant include prolonged exposure of the gastric mucosa to alkaline secretions as well as the mutagenic effect of ionizing radiation and alkylating drugs. It has been suggested that radiation and chemotherapy shorten the latency interval for the development of ''stump'' carcinoma. 2 A patient successfully treated for gastric lymphoma therefore should undergo periodic evaluation for the development of secondary gastric carcinoma.