Primary Gastric Hodgkin's Lymphoma Research Articles

A Case Report of Synchronous Primary Gastric Hodgkin Lymphoma and Lung Adenocarcinoma and Literature Review

We report a rare case of a 58-year-old woman who was initially diagnosed as primary gastric (PG) T-cell non-Hodgkin lymphoma, which later was revised as PG Hodgkin lymphoma (HL) with dissemination to the lung (stage IV). The lung lesion was later found to be lung adenocarcinoma (LA) and the diagnosis was revised again as synchronous primary gastric Hodgkin lymphoma (PGHL) and LA which, to our knowledge, was not reported before. This case illustrated the need of vigilance in the diagnosis of lymphoma at uncommon sites and the clinical challenges in managing synchronous malignancies. The rationale of clinical suspicion, the association between PGHL and Epstein–Barr virus, Helicobacter pylori, and other infections, and synchronous PGHL and LA were discussed.

Primary Gastric Hodgkinʼs Lymphoma

Introduction: Hodgkin's Lymphoma is a B-Cell lymphoma, that arises from germinal center or post-germinal center B cells. It accounts for 10 % of all lymphomas and approximately 0.6 % of all cancers diagnosed in the developed world annually. The gastrointestinal (GI) tract is the predominant site for extra-nodal involvement in lymphoma, with the stomach being the most common site. The GI tract is more commonly involved as secondary site than a primary site of involvement. We report a case of primary gastric Hodgkin's lymphoma. Case discussion: A 70-year-old woman presented with fever and significant weight loss. Contrast-enhanced computed tomography of the abdomen showed thickened gastric wall along the greater curvature and multiple enlarged peri-gastric lymph nodes. An upper endoscopy revealed an ulcerative lesion in the proximal body (a). Biopsies showed clusters of lymphocytes and occasional atypical cells with an “owl's eye” appearance, resembling Reed-Sternberg cells. Immunohistochemical stains were positive for CD 30, weakly positive for PAX5 and negative for CD 45, confirming Hodgkin's lymphoma. Positron emission tomography showed distant involvement of pulmonary lymph nodes. Patient was initiated on chemotherapy with adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) for stage IV disease. Stomach is the predominant extra-nodal site involved in lymphoma, usually as a secondary site. Occasionally, non-Hodgkin's lymphoma such as MALToma or diffuse large B cell lymphoma can present as primary gastric lymphoma. However, primary gastric Hodgkin's lymphoma is extremely rare. Diffuse mucosal involvement of the stomach and absence of prominent extra-gastric disease suggest primary gastric Hodgkin's lymphoma. Biopsies may not show the typical Reed-Sternberg cells; immunohistochemical stain is necessary for a definitive diagnosis. Prognosis is largely unknown with no clear guidelines for treatment, because of its rarity. Similar to prior reports, our patient responded favorably to chemotherapy and remains asymptomatic at 10 months. Conclusion: Primary gastric lymphoma can present insidiously without upper GI symptoms and can be easily missed in under-distended stomach on CT; but, attention to surrounding enlarged lymph nodes and history of constitutional symptoms should prompt evaluation with upper endoscopy with biopsies.FigureFigure

Primary gastric Hodgkin's lymphoma

Gastric Hodgkin's lymphoma is extremely rare. We present a case of primary Hodgkin's lymphoma arising in the stomach of a 65-year-old woman. The patient complained of epigastric discomfort and reflux for one month. Endoscopic examination revealed a protruding lesion characterized by a smooth surface at the antrum. An abdominal computed tomography uncovered a 2.5 × 2.0 cm, exophytic submucosal mass. After the tentative preoperative diagnosis of a gastrointestinal stromal tumor, a gastric wedge resection was performed. Microscopic examination of the mass demonstrated a diffuse proliferation of large atypical lymphoid cells with mono- and binucleated pleomorphic nuclei and prominent nucleoli. Immunohistochemically, the tumor cells were positive for CD30, CD20, and CD79a, whereas they were negative for cytokeratin, carcinoembryonic antigen, CD3, CD15, epithelial membrane antigen, and anaplastic lymphoma kinase-1. Based on the morphological features and immunohistochemical results, in addition to the clinical findings, a diagnosis of primary gastric Hodgkin's lymphoma was established.

Primary gastric Hodgkin lymphoma and metachronous early gastric carcinoma: a case report

Primary Gastric Hodgkin lymphoma is seen very rarely. Primary gastric Hodgkin lymphoma and gastric carcinoma in same patient is very very rare entity. Almost all of the primary gastric lymphoma cases are non-Hodgkin lymphoma type. We report the case of 45-year-old man with 3-month history of abdominal pain and weight loss. Upper gastrointestinal endoscopic examination revealed an ulcerated polypoid mass on greater curve of stomach and histopathological examination of biopsy showed adenocarcinoma. After near total gastrectomy, gastric Hodgkin lymphoma diagnosis was made, and postoperative 4 courses of doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) regimen were administered, and then total 3,600 cGy radiotherapy was delivered. After 7 years, during control examination, early gastric carcinoma was diagnosed. Our case is very rare entity of gastric Hodgkin lymphoma and metachronous gastric carcinoma. This case also shows the importance of follow-up of patients not only for the relapse of primary disease but also for the development of secondary malignancy which can be diagnosed at early curable stage.

Primary gastric Hodgkin's lymphoma

BackgroundPrimary Hodgkin's disease of the stomach is an extremely rare entity. Nearly all cases of primary gastric lymphoma are of the non-Hodgkin's variety. Diagnoses in such cases are difficult due to considerable histological similarities between the 2 disease entities.Case presentationWe report the case of a 77 year old lady with a 1 year history of weight loss and poor appetite. Physical examination was unremarkable. Subsequent multiple upper GI endoscopies revealed a large malignant looking ulcer which was deemed to be histologically benign. Following CT imaging the patient underwent a radical gastrectomy. Postoperatively histology and immunohistochemistry failed to confirm a diagnosis. As such a second opinion was sought. Employing an extended array of immunohistological staining a diagnosis of 'Classical Hodgkin's' disease of the stomach was achieved.ConclusionOur case illustrates the significant difficulties in achieving a rare diagnosis of primary Hodgkin's lymphoma of the stomach. The non-specific nature of symptoms and a lack of histological features make a preoperative diagnosis extremely difficult. While immunohistochemistry is widely employed in aiding the evaluation of such cases, one should be wary of the considerable overlap in differentiating between Hodgkin's and non-Hodgkin's disease entities using this technique.

Primary Gastric Hodgkin's Lymphoma Expressing a B-Cell Profile Including Oct-2 and Bob-1 Proteins

Classic Hodgkin's lymphoma (cHL) most often involves lymph nodes, and gastric involvement is rare. Hodgkin's and Reed-Sternberg (H-RS) cells in cHL are known to often lack expression of several B-lineage markers, such as CD20, CD79a, Oct-2, and Bob-1. We present an extremely rare case of mixed-cellularity cHL in the stomach in which expression of these B-cells was detected immunohistochemically. The patient was an 83-year-old Japanese woman who developed a sensation of abdominal fullness and appetite loss. Endoscopic and abdominal computed tomography examinations revealed a gastric ulcer lesion and swelling of para-aortic lymph nodes, respectively. A subtotal gastrectomy was performed, and the histopathologic diagnosis was established as a typical cHL compatible with stomach origin. The patient underwent postoperative chemotherapy of 3 cycles of ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) and has since been in complete remission. Immunohistochemically, the H-RS cells in the cHL were positive not only for CD30 but also for CD20, CD79a, Oct-2, and Bob-1, whereas they were negative for CD3, CD15, CD45, EMA, and ALK1. Our patient may have had an intermediate cHL disease overlapping that of non-Hodgkin's peripheral B-cell lymphoma, possibly reflecting derivation from germinal-center B-cells.

Primary gastric Hodgkin's lymphoma: A case report and review of the literature

Primary gastric Hodgkin's lymphoma is a rarely encountered lesion. Most cases are observed in the course of systemic disease. Other cases have been reclassified in retrospective studies as non-Hodgkin's lymphomas, after the employment of immunohistochemistry. Some Hodgkin's lymphomas may masquerade non-Hodgkin's lymphomas, and vice versa. Therefore, an accurate diagnosis is important, as treatment and outcome differ significantly for these entities. We report a case of primary Hodgkin's lymphoma arising in the stomach of a 46-year-old male, and discuss the diagnostic approach as well as the differentials of Hodgkin's disease in this anatomic site.