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Dr. Dharmesh J. Balsarkar and Dr Satish B Dharap Small B-cell lymphoma of stomach with metastasis to the anterior chest wall
Dr. Dharmesh J. Balsarkar and Dr Satish B Dharap, 11 October 2007
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Abstract

Metastasis to the anterior chest wall occurs mainly from primary thyroid or breast malignancies. Primary gastric lymphoma normally spreads to regional lymph nodes and in rare cases can become disseminated [1]. Primary gastric lymphoma with metastasis to the anterior chest wall as a primary presentation is rare. We report one such unusual case.

Introduction

Primary gastric lymphoma is defined as extra nodal lymphoma arising in the stomach [1]. It is uncommon malignancy and represents approximately 2% to 7% of gastric malignancies [1]. It generally spreads to regional lymph nodes, but can sometimes become disseminated [1]. Most primary gastric lymphomas are B cell in origin although occasional cases of T- cell and Hodgkin's lymphomas are seen [1].

Case report

A 54-year-old male presented with swelling over the anterior chest wall which had increased progressively over the past month and a half. Also noted was a history of significant weight loss and associated symptoms of pain in the epigastrium. The patient underwent a CT-scan of the chest and abdomen (Fig. 1) which showed a soft tissue mass anterior to the sternum and extending into the anterior mediastinum.

Fig.1. CT-scan of the chest showing the chest mass extending into the anterior mediastinum.

The stomach wall was thickened with the presence of peri-gastric lymph nodes (Fig. 2).

Fig.2. CT-scan of the abdomen showing the thickened stomach with peri-gastric lymph nodes.

The patient underwent an upper GI endoscopy in view of the CT scan findings and symptoms of pain in the epigastrium. Endoscopy showed the presence of multiple umbilicated lesions in the body and pyloric region of the stomach, which were biopsied (Fig.3).

Fig.3. Endoscopy image of the umbilicated lesions in the stomach.

An open biopsy of the chest lesion was also performed. Both the biopsies showed the features of B-cell lymphoma. Hence a diagnosis of primary B-cell lymphoma of the stomach with metastasis to the anterior chest wall was made. The patient was started on chemotherapy.

Discussion

Primary gastric lymphoma is an uncommon malignancy. It is defined as extra nodal lymphoma arising in the stomach. It normally spreads to regional lymph nodes and occasionally disseminates [1]. Most primary gastric lymphomas are B-cell in origin although occasional cases of T-cell and Hodgkin's lymphoma are seen [1]. Secondary gastric lymphomas indicate involvement of the stomach as a part of diffuse lymphoma arising elsewhere. Tertiary gastric lymphoma which is very rare and is defined as recurrent lymphoma involving the stomach after treatment of nodal lymphoma. Presented patient had stage 4e disease according to Musshoffs modified Ann-Arbor staging [2].

This article was first published on GastroHep.com in 2007.

References

  1. Dorenbeck U, Hollerbach S, Geissler A, Andus T. Pulmonary metastasis of extra nodal high malignancy B-cell Non-Hodgkin lymphoma of the bulbus duodeni and pylorus of the stomach. J. Gastroenterol 2000 Feb; 38(2): 173-176.
  2. Seong-Ho Kong, Min-A Kim, Do-Joong Park, Hyuk-Joon Lee, Hye-Seung Lee, Chul-Woo Kim, Han-Kwang Yang, Dae-Seog Heo, Kuhn-Uk Lee, Kuk-Jin Choe. Clinicopathologic features of surgically resected primary gastric lymphoma. . World J Gastroenterol 2004 April 15; 10(8): 1103-1109.

This article was first published on GastroHep in October 2007.

 
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