Gastric Adenocarcinoma Secondary to Primary Gastric Diffuse Large B-cell Lymphoma

Abstract

Despite the decreasing incidence and mortality from gastric cancer, it remains a major health problem worldwide. Ninety percent of cases are adenocarcinomas. Here, we report a case of gastric adenocarcinoma developed after successful treatment of prior primary gastric diffuse large B-cell lymphoma (DLBCL). Our patient was an elderly man with primary gastric DLBCL in whom complete remission was achieved after R-CHOP (cyclophosphamide, adriamycin, vincristine, prednisolone plus rituximab) chemotherapy. Helicobacter pylori infection persisted despite adequate treatment leading to sustained chronic gastritis. The mean time to diagnose metachronous gastric carcinoma was seven years. We believe that a combination of many risk factors, of which chronic H. pylori infection the most important, led to the development of gastric carcinoma following primary gastric lymphoma. In summary, patients who have been successfully treated for primary gastric lymphoma should be followed up at regular short intervals. H. pylori infection should be diagnosed promptly and treated aggressively.

Onset and Progression of Precancerous Lesions on Gastric Mucosa of Patients Treated for Gastric Lymphoma

“…Moreover, eradication therapy may lead to lymphoma regression in up to 15% of cases, even in H. pylori negative patients [19]. Unfortunately, there is evidence that patients with gastric lymphoma are at an increased risk of developing metachronous cancer of the stomach [1][2][3][4]. Such increased risk was putatively attributed to the persistence of lymphoma or chemotherapy [20,21].…”

“…There is some evidence suggesting that patients with primary gastric lymphoma are at an increased risk of developing adenocarcinoma of the stomach [1][2][3][4]. Indeed, a 6-16-fold increased incidence of gastric cancer in mucosa-associated lymphoid tissue (MALT)lymphoma patients has been calculated in epidemiological studies [5,6].…”