Two Cases of Diffuse Large B-Cell Lymphomas in the Cervical Lymph Nodes in Patients with Low-Grade Gastric Marginal Zone B-Cell Lymphoma (MALT Lymphoma)
In June 2005, a 55-year-old woman with hypothyroidism was referred to our department for epigastric discomfort from the department of endocrinology. EGD demonstrated mucosal surface granularity and 1 cm size mucosal elevation which had central depression on the lower body anterior wall (). Biopsy showed diffuse infiltration of atypical lymphocyte aggregation and glandular invasion of lymphocytes. Immunohistochemical staining showed atypical lymphoid cells that were positive for CD 20 but negative for CD 3, Ki-67 labeling index was 8%. Abdomen CT, chest CT, bilateral bone marrow examination, and PET were done for staging and there were no disease involvement at any other site. Pathologic diagnosis was low grade MALT lymphoma of the stomach at stage IE. RUT and UBT were positive. The patient took H. pylori eradication including clarythromycin, amoxicillin, and PPI for 14 days. Six months later, EGD was followed and confirmed complete histologic remission as well as endoscopic remission. RUT and UBT were all negative. In August 2006, 12 months after the first visit, EGD showed multiple erosions on the proximal antrum (). Biopsy showed recurred MALT lymphoma and H. pylori was also seen. RUT was positive, too. She took the second eradication of H. pylori infection with the same regimen during the same period of time. In November 2006, she visited our hospital complaining of palpable mass on both the lateral neck. Neck CT showed bilateral cervical lymph node enlargement (). Excisional biopsy showed diffuse infiltration of large atypical lymphoid cells. Immunohistochemical staining was positive for CD 20 and CD 79 but negative for CD 3. Ki-67 labeling index was 80%. These findings suggested DLBCL. In the staging work-up, there was no disease involvement except for both the neck nodes. EGD showed the second complete remission and RUT was negative. She was diagnosed with stage IIA DLBLC and took three cycles of R-CHOP followed by radiotherapy of 3,600 cGr. In April 2007, DLBCL and gastric MALT lymphoma regressed completely. RUT was negative. In December 2008, DLBCL and gastric MALT lymphoma remained in complete remission state and RUT was negative. Until recently she has maintained complete remission state of DLBCL and gastric MALT lymphoma and negative RUT.