Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2023 Nov 1;62(21):3237-3240.
doi: 10.2169/internalmedicine.0977-22. Epub 2023 Apr 7.

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

Ken Suzaki  1 , Masayuki Kobayashi  1 , Nobuharu Kosugi  1
Affiliations
Case Reports

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

Ken Suzaki et al. Intern Med. .

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.

PubMed Disclaimer

Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
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.
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.
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).
See this image and copyright information in PMC

References

    1. Ashihara K, Yamada S, Sekiguchi T, et al. A case of penetrating diffuse large B cell lymphoma of the stomach with closure of penetration by conservative medical treatment. Endosc Forum Dig Dis 33: 96-100, 2017(in Japanese, Abstract in English).
    1. Cirocchi R, Farinella E, Trastuli S, et al. Surgical treatment of primitive gastro-intestinal lymphomas: a systematic review. World J Surg Oncol 9: 145, 2011. - PMC - PubMed
    1. Vaidya R, Habermann TM, Donohue JH, et al. Bowel perforation in intestinal lymphoma: incidence and clinical features. Ann Oncol 24: 2439-2443, 2013. - PMC - PubMed
    1. Fukuda N, Tachibana A, Yamakawa T, Sakai S, Kasugai H, Uni J. A case of gastric malignant lymphoma with gastric perforation. Nihon Rinsho Geka Gakkai Zasshi (J Jpn Surg Assoc) 59: 698-701, 1998(in Japanese, Abstract in English).
    1. Maisey N, Norman A, Prior Y, Cunningham D. Chemotherapy for primary gastric lymphoma: does in-patient observation prevent complications? Clin Oncol (R Coll Radiol) 16: 48-52, 2004. - PubMed

Publication types

MeSH terms