Synchronous duodenal mucosa-associated lymphoid tissue lymphoma and gastric cancer
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CASE REPORT
Synchronous duodenal mucosa‑associated lymphoid tissue lymphoma and gastric cancer Keiichiro Yokota1 · Tsutomu Namikawa1 · Masahiro Maeda1 · Nobuhisa Tanioka1 · Jun Iwabu1 · Sunao Uemura1 · Masaya Munekage1 · Hiromichi Maeda1 · Hiroyuki Kitagawa1 · Michiya Kobayashi2 · Kazuhiro Hanazaki1 Received: 22 June 2020 / Accepted: 11 September 2020 © Japanese Society of Gastroenterology 2020
Abstract Duodenal mucosa-associated lymphoid tissue (MALT) lymphoma is an extremely rare tumor. Herein, we report multidisciplinary treatment of a patient with synchronous development of primary MALT lymphoma of the duodenum and gastric cancer. A 70-year-old woman was referred to our hospital for examination of a gastric cancer initially diagnosed by a local medical doctor. Esophagogastroduodenoscopy showed an elevated lesion with a central ulcer in the lower body of the stomach, and a partially whitish aggregated lesion in the descending portion of the duodenum. Histopathological examination of biopsy specimens from the gastric lesion showed moderately differentiated adenocarcinoma, and duodenal specimens showed low-grade MALT lymphoma composed of atypical lymphoid cells with a lymphoepithelial lesion. The patient underwent distal gastrectomy with regional lymph node dissection for the gastric cancer. Histological examination showed muscularis propria invading adenocarcinoma with two lymph node metastases. After operation, four courses of systemic rituximab treatment were administered for the MALT lymphoma, followed by adjuvant S-1 (tegafur/gimeracil/oteracil) chemotherapy for the gastric cancer. In the 4 months after operation, the patient was well with no evidence of recurrence. To the best of our knowledge, this is the second reported case of synchronous gastric adenocarcinoma and duodenal MALT lymphoma in the English literature. Keywords Gastric cancer · Lymphoma · Mucosa-associated lymphoid tissue · Duodenum · Rituximab
Introduction Malignant lymphoma of mucosa-associated lymphoid tissue (MALT) is defined as an extranodal lymphoma composed of heterogeneous B cells, which most frequently develops from the gastric mucosa, and accounts for more than 75% of gastrointestinal tract lymphomas [1]. This tumor includes small lymphocytes with round nuclei and clumped chromatin, monocytoid cells, and plasmacytoid cells. In the gastrointestinal tract, the tumors most frequently arise from the stomach, small intestine, cecum, and rectum in that order, but duodenal MALT lymphoma is extremely rare [2], with
* Tsutomu Namikawa tsutomun@kochi‑u.ac.jp 1
Department of Surgery, Kochi Medical School, Kohasu, Oko‑cho, Nankoku, Kochi 783‑8505, Japan
Department of Human Health and Medical Sciences, Kochi Medical School, Nankoku, Kochi, Japan
2
an estimated frequency of approximately 0.9% of all gastrointestinal malignant lymphomas [3]. In this report, we present a case of synchronous duodenal MALT lymphoma and gastric cancer in a 70-year-old woman and its multidisciplinary treatment. The clinical characteristics and treatment
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