A Snowy White Stomach, Caused by Primary Gastric Anaplastic Large-Cell Lymphoma

A Snowy White Stomach, Caused by Primary Gastric Anaplastic Large-Cell Lymphoma

Accepted Manuscript A Snowy White Stomach, Caused by Primary Gastric Anaplastic Large-cell Lymphoma Masaya Kobayashi, Ikuo Matsuda, Hiroto Miwa PII: ...

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Accepted Manuscript A Snowy White Stomach, Caused by Primary Gastric Anaplastic Large-cell Lymphoma Masaya Kobayashi, Ikuo Matsuda, Hiroto Miwa

PII: DOI: Reference:

S1542-3565(16)30553-5 10.1016/j.cgh.2016.08.012 YJCGH 54867

To appear in: Clinical Gastroenterology and Hepatology Accepted Date: 13 August 2016 Please cite this article as: Kobayashi M, Matsuda I, Miwa H, A Snowy White Stomach, Caused by Primary Gastric Anaplastic Large-cell Lymphoma, Clinical Gastroenterology and Hepatology (2016), doi: 10.1016/j.cgh.2016.08.012. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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A Snowy White Stomach, Caused by Primary Gastric Anaplastic Large-cell

Kobayashi, Masaya1 ([email protected])

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Miwa, Hiroto1 ([email protected])

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Matsuda, Ikuo2 ([email protected])

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Lymphoma

1. Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya-city, Hyogo, Japan Department

of

Surgical

Pathology,

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2.

Hyogo

College

of

Medicine,

Nishinomiya-city, Hyogo, Japan

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Conflict of Interest: The authors declare no conflict of interest associated with

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this manuscript.

A 63-year-old Japanese woman suffering from a history of bloating and epigastric pain came to our hospital. Physical examination was unremarkable. Peripheral blood test showed anemia (10.5 g/dL of hemoglobin) and low albumin (1.9 g/dL). She had undergone abdominal myomectomy 20 years before.

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Esophagogastroduodenoscopy revealed that the luminal surface of her stomach was diffusely covered with snowy white coat (Figure A). Contrast-enhanced

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computed tomography showed extensive wall thickening of the stomach without any lymph node swelling, ascites and metastasis (Figure B, indicated by arrow

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heads). Initially the biopsy of her stomach showed severe suppurative

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inflammation only (data not shown). However, after the control of the inflammation, hematoxylin-eosin image of the subsequent biopsy of the stomach revealed diffuse proliferation of large anaplastic cells (Figure C), whose immunophenotype was CD3- and CD30-positive while anaplastic lymphoma

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kinase (ALK)-negative (Figure C). The tumor cells were CD56-negative as well (data not shown). The diagnosis was established as primary gastric anaplastic

vedotin

plus

CHP

(cyclophosphamide,

doxorubicin

and

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brentuximab

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large cell lymphoma (ALCL), ALK-negative. She was administered with

prednisone).

Primary ALCL of the stomach is reported to constitute only 0.8 % of the primary gastric lymphoma.1 Thus, primary gastric ALCL, ALK-negative, is presumed to be rarer than 0.8 %. ALCL is characterized by large anaplastic lymphoid cells with expression of CD30. ALK-negative ALCL is a clinical entity

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distinct from ALK-positive ALCL in terms of treatment and prognosis.2 Therefore, histopathological diagnosis of ALK-negative ALCL is critical for correct

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management of the patient.2

The diagnosis of the present case was challenging because severe necrosis

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with inflammation, which endoscopically appeared to be ‘snowy white coat’,

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masked the presence of the tumor cells underneath at the initial stage of the disease. Only after the control of the inflammation, the gastric biopsy revealed the tumor cells with anaplastic features. Primary gastric ALCL may be a diagnostic challenge, not only because it is rare and a histological mimicker of

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poorly differentiated adenocarcinoma, but also it endoscopically masquerades

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as severe inflammation just as illustrated in the present case.

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References

1. Iwamizu-Watanabe S, Yamashita Y, Yatabe Y, et al. Frequent expression of CD30 antigen in the primary gastric non-B, non-Hodgkin lymphomas. Pathol Int. 2004;54(7):503-509. 2. Kerry J. Savage, Nancy Lee Harris, Julie M. Vose, et al. ALK− anaplastic large-cell lymphoma is clinically and immunophenotypically different from both

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ALK+ ALCL and peripheral T-cell lymphoma, not otherwise specified: report from the International Peripheral T-Cell Lymphoma Project. Blood

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2008;111:5496-5504

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