A 75-year-old male was admitted in November, 1980, for systemic hemorrhage maculae. No superficial lymph node swelling or splenohepatomegaly was observed at admission. Results of blood test were; RBC 310×104/cmm; Hb 9.2 g/dl; Ht 27.9%; reticulocytes 0.6%; WBC 6,800/cmm with almost normal differentials; and PLT 1.4×104/cmm. A bone marrow was of hypercellularity, and megakaryocytes were increased. No pathological cells were observed, but Bormann type I adenocarcinoma was detected at the cardia. Observation of the patient's progress was continued after blood transfusions. Immature lymphocyte-like cells started to develop in the peripheral blood after 15 months, and the patient died of a heavy hemorrhage in the digestive tract that occurred 1 month later. Many thumbnail-sized lymph node swelling mainly in the posterior peritoneum were noted at autopsy. Histological findings were diffusive large cell-type malignant lymphoma with leukemic change. Diffuse and reactive proliferation of histiocytes with erythrophagocytosis were seen in the lymph node, presenting a malignant histiocytosis-like finding. The gastric carcinoma did not extend beyond the muscular layer of the mucosa, and no metastasis to any organ was observed. The proliferation of the histiocytes in this case is presumed to have resulted from stimulation caused in the tissue of the reticuloendothelial system by the gastric carcinoma and to have become a factor for developing hematopenia to a high degree, the occurrence of which is comparatively rare for an initial malignant lymphoma symptom.
