An unusual case of gastric lymphoma presenting as linitus plastica

Abstract

Disorders of the stomach are frequently seen as clinical diseases. Of all the lesions of the stomach, inflammatory conditions and neoplastic lesions are most common. Primary malignant lymphoma of the stomach accounts for only a small percentage (about 10%) of all malignant tumors of the stomach, and majority of them arise from B-cells. Most common among these are indolent extranodal marginal zone lymphomas, and in the stomach, they are called MALTomas. Occasionally, gastric lymphomas of one type or another are seen adjacent to adenocarcinoma. Sometimes, lymphoma precedes carcinoma by several years. The aim was to study the microscopic patterns of gastric biopsies and mastectomy specimens received for the case in our department. Multiple gastric biopsy specimens as well as gastrectomy specimens were received in our department. Multiple sections were taken and stained with hematoxylin and eosin. Immunohistochemical (IHC) stains were used as applicable. Studies posed a diagnostic difficulty by showing picture of gastritis from biopsy of the cardia; signet ring cell adenocarcinoma was seen in small gastrointestinal biopsies from lesser curvature and gastric lymphoma with gross picture of linitis plastica on gastrectomy specimen. For confirmation and to know the type of gastric lymphoma, multiple B- and T-cell IHC markers were used. CD20, CD10, BCL2, and c-Myc were positive in tumor cells, CD3 positivity was seen in reactive T-cells, and MIB1 positivity was seen in 70%–75% of tumor cells. Hence, it was confirmed to be high-grade large cell lymphoma (double-expresser type). Hence, it can be concluded that IHC markers are necessary to solve the diagnostic difficulties.

Keywords

• immunohistochemistry
• linitis plastica
• lymphoma