Non-operative Management of Spontaneous Gastropleural Fistula Caused by Primary Gastric Diffuse Large B-cell Lymphoma

Abstract

We herein report a 79-year-old man diagnosed with primary gastric diffuse large B-cell lymphoma (DLBCL) with gastropleural fistula (GPF), successfully treated by chemotherapy without surgery. If primary gastric DLBCL perforates during chemotherapy, surgery is often warranted. Our patient's computed tomography findings showed loculated pleural effusion with air foci in the left lower lobe, suggesting GPF. After six cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy, the fistula fully closed, and complete remission was achieved. In conclusion, while gastric DLBCL can exhibit spontaneous GPF, it can be treated with chemotherapy alone, which was well-tolerated in our patient.

Keywords: chemotherapy; gastric diffuse large B-cell lymphoma; gastropleural fistula.

Figure 1.

An endoscopic examination of the gastrointestinal tract. (A) Before chemotherapy, the tumor formed a massive ulcer at the fornix. (B) After two cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy, the ulcer regressed. (C) After six cycles of R-CHOP, the ulcer remitted.

Figure 2.

Histopathology of biopsy samples. (A) Hematoxylin and Eosin staining (original magnification ×100). (B-F) Immunohistochemistry: (B) anti-CD20; (C) anti-CD79a; (D) anti-CD10; (E) anti-BCL-2; and (F) anti-Ki-67. [(B-E); original magnification ×40, (F); original magnification ×100].

Figure 3.

Coronal computed tomography and positron emission tomography combined with CT. (A) Coronal computed tomography image on presentation showing a bulky stomach tumor infiltrating the left diaphragm. (B) Positron emission tomography combined with CT did not disclose any other strong tracer uptake. (C) After the first chemotherapy cycle, GPF was clearly observed on coronal computed tomography (arrow).