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Rapid Growing Gastric Cancer Diagnosed During Follow-up of Gastric Mucosa-associated Lymphoid Tissue (MALT) Lymphoma Tadanobu Nagaya 1 , Taiji Akamatsu 2 , Haruaki Shirakawa 1 , Kei Kitahara 1 , Kenichi Suzawa 1 , Yasunori Kaneko 1 , Hiroyasu Saito 3 , Naohiko Koide 3 , Tsuyoshi Uehara 4 , Jun Nakayama 5 , Eiji Tanaka 1 1Department of Internal Medicine, Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan 2Department of Endoscopy, Shinshu University Hospital, Matsumoto, Japan 3Department of Surgery, Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan 4Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan 5Department of Pathology, Shinshu University School of Medicine, Matsumoto, Japan Keyword: 急速進行性 , 低分化癌 , MALTリンパ腫 , vimentin陽性 pp.1248-1254
Published Date 2008/7/25
DOI https://doi.org/10.11477/mf.1403101426
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 A 60-year-old man was referred to Shinshu University Hospital in June 2000, for further examination and treatment of a gastric neoplasm. He underwent an esophagogastroduodenoscopy (EGD), and histological findings of the biopsy specimens obtained from the whitish gastric mucosa in the lesser curvature of the lower body revealed infiltrations of atypical lymphoid cells and lymphoepitherial lesions. Immunohistochemical studies strongly suggested low grade MALT lymphoma of the stomach. Helicobacter pylori (Hp) infection was not detected although atrophic change of the gastric mucosa and intestinal metaplasia were recognized, suggesting past infection of Hp. At first, he received eradication therapy against Hp and, consequently, infiltrations of atypical lymphoid cells were shown to have regressed remarkably. After that, the patient was followed up at regular intervals including EGD, with no further treatment. EGD showed no abnormal finding in the stomach except atrophic change in May, 2004, but a large tumor with central ulceration was detected in the lesser curvature of the middle portion of the stomach in October, 2005. Judging from endoscopic findings, we considered the possibility that MALT lymphoma might transform into diffuse large B-cell lymphoma. However, histological findings of biopsy specimens showed poorly differentiated adenocarcinomas that were diffusely positive for immunostaining using Ki-67. He underwent total gastrectomy, and the tumor size was 80×75 mm. Histopathological diagnosis was as follows;por 1, pT2 (SS), int, INFβ, ly3, v2, p0, pDM (-), pN1. Immunohistochemical study showed that carcinoma cells were positive for not only cytokeratin but also vimentin. This finding revealed that this cancer had both phenotypes of epithelial cells and non epithelial cells, and was characterized by very undifferentiated cells. He died of recurrence of gastric cancer in June, 2006.


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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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