Synchronous Adenocarcinoma Stomach With Marginal Zone Lymphoma: A Sporadic Occurrence and Review of Literature

Abstract

Synchronous adenocarcinoma of the stomach with lymphoma is extremely rare. We report a case of a 65-year-old male patient with synchronous adenocarcinoma of the stomach with nodal marginal zone lymphoma. Initial endoscopic biopsy suggested invasive moderately differentiated adenocarcinoma and a locoregional disease, per contrast-enhanced computed tomography (CECT) scans. The patient was started on neo-adjuvant chemotherapy with the 5FU, leucovorin, oxaliplatin, docetaxel (FLOT) regime and, after response evaluation, underwent radical gastrectomy. Histopathology and immunohistochemistry suggested synchronous adenocarcinoma of the stomach with marginal zone lymphoma in perigastric lymph nodes. This case is probably the first such synchronous malignancy case reported from India. The prognosis of multiple primary malignancies is usually poor because no standard guidelines are available regarding optimum treatment and sequencing of available treatment modalities. The frequency of synchronous primary cancers has been increasing in recent years, probably due to better diagnostic modalities, and second primary in patients with cancer should be considered as one of the differential diagnoses.

Keywords: gastric; lymphoma; smpc; stomach; synchronous.

Figure 1. 1A: Gastric biopsy Haematoxylin and Eosin (H&E) staining in 10X magnification showing malignant cells arranged in acini, cords invading the stroma, 1B: H&E 40X magnification showing malignant cells with an elongated hyperchromatic nucleus and scant cytoplasm, S/O Intestinal type adenocarcinoma

Figure 2. Perigastric lymph nodes with Haematoxylin and Eosin (H&E) staining in 40X magnification, showing architectural effacement of lymph node with replacement by the population of monotonous small to medium-sized lymphoid cells

Figure 3. IHC on perigastric lymph nodes showing CD 20 strongly positive, while negative for CD5, CD 10, MUM-1, Bcl-6 with Ki-67 value 05%

Figure 4. Section from linear cores of the liver with H&E, 40X magnification showing infiltrative glands of varying sizes in a crowded arrangement, lined by atypical cells, set against desmoplastic stroma.

Figure 5. IHC for Mismatch Repair proteins (MMR) showing retained expression for MLH1, PMS2, MSH6, and MSH2