부산대학교 도서관

An 80-year-old man was referred to our hospital for further examination and treatment of a gastric tumor that had been observed on upper gastrointestinal endoscopy at a neighboring hospital. Endoscopic examination of an elevated mass with focal ulceration on the upper gastric body and biopsy specimens revealed poorly differentiated adenocarcinoma. Computed tomography (CT) scan showed multiple mediastinal and intra-abdominal lymphadenopathies. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was performed on the enlarged intra-abdominal lymph nodes using a 21-gauge needle via the gastric wall and microscopic examination of the material obtained by EUS-FNA showed no evidence of metastatic adenocarcinoma. Immunohistological staining and flow cytometry led to the diagnosis of mantle cell lymphoma. The final diagnosis was stageIVA mantle cell lymphoma and synchronous gastric adenocarcinoma. R-CHOP chemotherapy was performed. Follow-up CT scan obtained one month later showed a decrease in the size of the lymphadenopathies. EUS-FNA of intra-abdominal lymphadenopathy is a promising diagnostic technique that can aid treatment decisions in patients with synchronous malignant lymphoma with primary gastric cancer.