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• W2613367095 abstract "Letters to the EditorConcomitant Lymphoma and Carcinoma Mohamed I. Yasawy, MD, DTM Abdel Rahman El-Shiekh Mohammed, FRCP, DTM&H, DipVen Mohamed Ali Al-Karawi, Facharzt(W. Germany) Kamla H. Sidky, and MBCHB Muffak JawdatFacharzt Mohamed I. Yasawy Department of Gastroenterology Search for more papers by this author , Abdel Rahman El-Shiekh Mohammed Department of Gastroenterology Search for more papers by this author , Mohamed Ali Al-Karawi Department of Gastroenterology Search for more papers by this author , Kamla H. Sidky Department of Pathology Search for more papers by this author , and Muffak Jawdat Department of Surgery, Riyadh Armed Forces Hospital, P.O. Box 7897, Riyadh 11159, Saudi Arabia Search for more papers by this author Published Online:1 Jul 1991https://doi.org/10.5144/0256-4947.1991.479aSectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionTo the Editor: Gastroscopy was performed on a 66-year-old man because of a nine month history of epigastric pain and weight loss (20 kg). Gastroscopy revealed a polypoid stomach tumor involving the whole lesser curvature and extending into the cardia. Gastric biopsies were taken which showed adenocarcinoma.Clinical examination showed a healthy looking man, weighing 85 kg. A right supraclavicular lymph node was enlarged (1.5 cm in diameter) as well as axillary and inguinal lymph nodes. The spleen was slightly enlarged.Full blood count (CBC), urea and electrolytes, liver function tests, urine analysis, chest x-ray, and barium enema were all normal.Abdominal CT scan showed the presence of a gastric lesion with enlarged para-aortic and iliac lymph nodes. Supraclavicular lymph node biopsy revealed non-Hodgkin's lymphoma of the large cell immunoblastic type (Kiel classification). Bone marrow aspiration showed marrow infiltration by malignant lymphoma.At operation, a huge stomach mass was present which involved the lesser curvature and posterior wall of the stomach. The para-aortic and mesenteric lymph nodes were enlarged and intraperitoneal spread was present. Total gastrectomy, splenectomy, greater omentectomy, esophagojejunostomy and jejunostomy by Roux-en-Y anastomosis were performed. A wedge liver biopsy was also taken.The gastrectomy specimen showed a huge ulcerating growth on the lesser curvature measuring 6.5 × 3.5 cm, approaching the esophagogastric junction and invading the entire gastric wall thickness. The lesser curvature lymph nodes were enlarged forming a mass 6 × 5.5 × 4 cm. The omentum contained lymph nodes infiltrated by tumor. The spleen was enlarged weighing 340 gm and the cut surface revealed pale tumor deposits. The stomach was infiltrated by adenocarcinoma which extended to the serosa. In addition, the mucosa contained numerous lymphomatous deposits. The lesser curvature lymph nodes and omentum contained both malignant lymphoma and metastatic adenocarcinoma (Figure 1).Figure 1. Subcapsular sinus of lymph node infiltrated by adenocarcinoma showing signet ring cells. (Periodic acid-Schiff; original magnification × 100.)Download FigureMalignant lymphoma and adenocarcinoma (Figure 2) were also present in the liver biopsy which also contained a schistosoma ovum granuloma. The lymphomatous infiltrates were diffuse and consisted of a mixture of small and large cells.Figure 2. Adenocarcinoma with PAS-positive diastase resistant mucin adjacent to malignant lymphoma involving the liver. (Periodic acid-Schiff; original magnification × 200.)Download FigureAdenocarcinoma is the commonest tumor of the stomach and synchronous carcinomas occurred in 1.25% of cases[1,2]. While gastric involvement by Hodgkin's disease remains rare, there has been an increase in non-Hodgkin's gastric lymphoma[3].Rarely malignant lymphoma and adenocarcinoma (collision tumors) have been reported[4,5]. Collision tumors have been defined as two primary histologically different malignancies developing in the same organ in close contact with little intermingling. Less than 40 cases have been reported, with most collision tumors found between the fifth and seventh decades, being about six times more common in males. Causal relationship in synchronous development of these collision tumors is uncertain. Possibly the two tumors arise independently under the influence of the same carcinogenic action or that one tumor may produce the other.Cornes[6] reported six cases of malignant lymphoma and adenocarcinoma of the gastrointestinal tract, noting that the relationship between them is uncertain.Collision tumors of the gastrointestinal tract are usually malignant lymphoma and adenocarcinoma with malignant lymphoma usually predominating at the time of diagnosis[1]. Thus, our case is unusual in that both tumors occurred simultaneously.The coexistence of two malignant tumors (“collision tumors”) in one organ presents an interesting histological and clinical entity, with less than 40 cases having been reported in the literature.ARTICLE REFERENCES:1. Planker M, Fischer JTH, Peter U, Borchard F. Synchronous double malignant lymphoma . Hepato-gastroenterology. 1984; 31: 144–8. Google Scholar2. Moertel CG, Bargen JA, Soule EH. Multiple gastric cancers: review of the literature and study of 42 cases . Gastroenterology. 1973; 32: 961–8. Google Scholar3. Kile TS, Goldstein F. Malignant lymphoma involving the stomach . Cancer. 1973; 32: 961–8. Google Scholar4. Jernstrum P, Murray CG. Synchronous double primary lymphosarcoma and adenocarcinoma (collision tumor) of the stomach with cancer to cancer metastasis . Cancer. 1966; 19: 60–6. Google Scholar5. Rabinovitch J, Peres B, Grayze D. Co-existing lymphosarcoma and ulcerating carcinoma of the stomach . Arch Surg. 1952; 64: 185–91. Google Scholar6. Cornes JS. Multiple primary cancers: malignant lymphomas and carcinoma of intestinal tract in the same patient . J Clin Pathol. 1960; 13: 483–9. Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 11, Issue 4July 1991 Metrics History Published online1 July 1991 InformationCopyright © 1991, Annals of Saudi MedicinePDF download" @default.
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