Gastric lymphoma

Case contributed by Dr Fadi Aidi

Presentation

Patient presented with upper abdominal discomfort, significant weight loss, anorexia and early satiety.

Patient Data

Age: 55-60
Gender: Male
Ultrasound

Ultrasound of the upper abdomen shows marked circumferential asymmetrical wall thickening and obscuration of the normal layers of the distal stomach. These changes extend to the proximal duodenum.

The visualized part of stomach shows some luminal narrowing.

No visible adjacent lymphadenopathy.

Pathology report:

GROSS

Specimen fixed labelled with patient’s name, consists of multiple gray white soft tissue. 

MICROSCOPIC

Specimen is composed at large of necroinflammatory tissue "ulcer site", with
only one fragment showing viable gastric mucosa, showing infiltration of
lamina propria by sheets of large atypical lymphoid- like cells, with scattered
mitotic figures. Immunohistochemical stain including CD20, CD3, Ki67 and
CK are necessary for further sub-classification and to exclude undifferentiated carcinoma.

DIAGNOSIS: Stomach, biopsy: Malignant tumour, with features of high-grade non-Hodgkin lymphoma, for immunohistochemical stains. 

Case Discussion

In this case, we advised further evaluation with contrast-enhanced CT, but the patient's treating physician opted for biopsy.

The stomach is the most common site of gastrointestinal tract lymphoma, extranodal lymphoma, and MALT lymphoma.

Features that can help differentiate lymphoma from gastric carcinoma is that the wall thickening is more marked in lymphoma and extension to the duodenum is typical for lymphoma. Infiltration of adjacent organs is more likely in carcinoma. However, there is an overlap in the imaging appearance of the two conditions. 

PlayAdd to Share

Case information

rID: 51766
Case created: 6th Mar 2017
Last edited: 27th Mar 2017
Inclusion in quiz mode: Excluded

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.