Abstract
BackgroundAlthough the first-line therapy for early-stage gastric mucosa-associated lymphoid tissue lymphoma is the eradication of Helicobacter pylori, the effect of eradication in Helicobacter pylori-negative cases is unclear. In this case report, we describe a surgical option for a case of Barrett’s esophageal cancer with concurrent gastric mucosa-associated lymphoid tissue lymphoma.Case presentationA 79-year-old man was admitted to our hospital with Barrett’s esophageal cancer and gastric mucosa-associated lymphoid tissue lymphoma. Initially, we performed endoscopic submucosal dissection for Barrett’s esophageal cancer. Since residual tumor was observed after the endoscopic submucosal dissection, we performed an esophagectomy with two-field lymph node dissection, which was followed by placement of a gastric conduit via the posterior mediastinal route. He was discharged 14 days after surgery. Although no additional treatment exists for mucosa-associated lymphoid tissue lymphoma, no recurrent disease has been detected to date.ConclusionAn option to use a portion of the stomach with low-grade malignant mucosa-associated lymphoid tissue lymphoma as a conduit after esophagectomy was suggested.
Highlights
The first-line therapy for early-stage gastric mucosa-associated lymphoid tissue lymphoma is the eradication of Helicobacter pylori, the effect of eradication in Helicobacter pylori-negative cases is unclear
Patients with gastric Mucosa-associated lymphoid tissue (MALT) lymphoma can be asymptomatic or may present with vague complaints of dyspepsia. Such a malignancy is associated with autoimmune disorders or chronic inflammation, which in most cases is caused by Helicobacter pylori (Hp) infection
According to the European Society of Medical Oncology guidelines for gastric MALT lymphoma [6], the patient was classified as stage I based on the Lugano staging system
Summary
Barrett’s esophagus is present in 10–20% of patients with gastroesophageal reflux disease and 2–7% of the general population, with an incidence between 23.1 and 32.7 per 100,000 individuals [1]. Subtotal esophagectomy followed by reconstruction using a gastric conduit is a standard procedure in patients with esophageal cancer [4]. For the patient with Barrett’s esophageal cancer presented here, we used the stomach with MALT lymphoma as the organ for reconstruction of the esophagus. Pathologic analysis showed a welldifferentiated adenocarcinoma with short-segment Barrett’s esophagus, 0-IIc, 30 × 20 mm, pT1a-SMM ly0 v0 N0 M0, and pStage0 according to the 8th edition of the UICC TNM staging system. This patient was diagnosed with MALT lymphoma of the cell component in the large abdominal lymph node (Fig. 4b).
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