Gastric Perforation Caused by Primary Gastric Diffuse Large B Cell Lymphoma

Ju Seok Kim; Woo Sun Rou; Byung Moo Ahn; Hee Seok Moon; Sun Hyung Kang; Jae Kyu Sung; Hyun Yong Jeong; Kyu-Sang Song

doi:10.4166/kjg.2015.65.1.43

Journal List > Korean J Gastroenterol > v.65(1) > 1007392

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Kim, Rou, Ahn, Moon, Kang, Sung, Jeong, and Song: Gastric Perforation Caused by Primary Gastric Diffuse Large B Cell Lymphoma

Case Report

Korean J Gastroenterol 2015;65(1):43-47.

Published online: 4 October 2015

DOI: https://doi.org/10.4166/kjg.2015.65.1.43

Gastric Perforation Caused by Primary Gastric Diffuse Large B Cell Lymphoma

Ju Seok Kim, Woo Sun Rou, Byung Moo Ahn, Hee Seok Moon, Sun Hyung Kang, Jae Kyu Sung, Hyun Yong Jeong, Kyu-Sang Song¹

Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea

¹Department of Pathology, Chungnam National University School of Medicine, Daejeon, Korea

Correspondence to: Hee Seok Moon, Department of Internal Medicine, Chungnam National University College of Medicine, 282 Munwha-ro, Jung-gu, Daejeon 301- 721, Korea. Tel: +82-42-280-7143, Fax: +82-42-257-5753, E-mail: mhs1357@cnuh.co.kr

Received 25 June 201430 July 2014 Accepted 1 August 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Spontaneous gastric perforation is a rare complication of gastric lymphoma that is potentially life threatening since it can progress to sepsis and multi-organ failure. Morbidity also increases due to prolonged hospitalization and delay in initiating chemotherapy. Therefore prompt diagnosis and appropriate treatment is critical to improve prognosis. A 64-year-old man presented to the emergency department with severe abdominal pain. Chest X-ray showed free air below the right diaphragm. Abdominal CT scan also demonstrated free air in the peritoneal cavity with large wall defect in the lesser curvature of gastric lower body. Therefore, the patient underwent emergency operation and primary closure was done. Pathologic specimen obtained during surgery was compatible to diffuse large B cell lymphoma. Fifteen days after primary closure, the patient received subtotal gastrectomy and chemotherapy was initiated after recovery. Patient is currently being followed-up at outpatient department without any particular complications. Herein, we report a rare case of gastric lymphoma that initially presented as peritonitis because of spontaneous gastric perforation.

Keywords: Gastric lymphoma, Perforation

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Fig. 1.

Chest X-ray findings. Free air is seen below the right diaphragm.

Fig. 2.

Abdominal CT scan findings. A large wall defect (arrows) and edema-tous thickening are noted in the lesser curvature of gastric lower body (A, transverse view; B, coronal view).

Fig. 3.

Microscopic findings. Diffuse proliferation of medium to large sized lymphocytes having vesicular nuclei with smooth chromatin and scant cytoplasm are observed (H&E; A, ×100; B, ×400). Immunohistochemistry staining shows that the tumor cells are positive for CD 20 (C, ×100) and leukocyte common antigen (D, ×100).

Fig. 4.

Endoscopic and gross findings.(A) An ulcerative lesion extending from the lesser curvature of gastric lower body to the gastric angle can be seen.(B) Suture line is observed on the anterior side of the lesion. (C, D) The resected specimen demonstrates a ulceroinfiltrative lesion containing 3.0×1.8 cm sized tumor in the lesser curvature of lower body.

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