Abstract
A case of primary early gastric malignant lymphoma which was diagnosed preoperatively by characteristic findings in an upper GI X-ray examination is reported.
The patient, a 42-year-old man, was examined for nausea and vomiting over a period of nine months. Two years prior to admission, he was treated in another hospital for benign gastric ulcer. Current upper GI X-ray examination showed a IIc-like superficial depression extending from the middle gastric body to the pylorus. In the depression, multiple irregular ulcers with intervening nodularity were seen (Figs. 1, 2). These X-ray findings were considered characteristic of early gastric malignant lymphoma, which was later confirmed by a gastrofiberscope (Figs. 3, 4) and histologic examination of a biopsied specimen. The patient underwent subtotal gastrectomy (R2) (Fig. 5, 6). Histopathologically, tumor cells were seen in the mucosal and submucosal layers (sm) (Fig. 7), and a diagnosis-diffuse malignant lymphoma, large cell type, as based on the Lymphoma Study Group classification-was made (Fig. 8). Metastases involving lymph nodes of the lesser curvature (No. 3) were found and he was considered to be at stage II of the Nagvi staging system. He was placed on combination chemotherapy (vincristine 4mg, Endoxan 1500mg, prednisolone 3500mg). His postoperative course was uneventful, and he is currently leading a normal life three years after surgery.
