ABSTRACT
A 68-year-old female was diagnosed with follicular lymphoma (FL) grade 2, based on the excisional biopsy of her enlarged left cervical lymph node. Positron-emission tomography/computed tomography (PET/CT) revealed the 18F-fluoro-deoxyglucose-avid lesions in the sigmoid colon and at the fundus of the gallbladder, besides those in the left neck. A sigmoid colon polyp, which was endoscopically resected, proved histologically to be a well- to moderately-differentiated tubular adenocarcinoma with deep invasion into the submucosa. In addition, nodular lesions of the gallbladder were enhanced on dynamic CT, markedly suggesting gallbladder carcinoma. Among FL, colorectal cancer, and presumed gallbladder adenocarcinoma, FL was considered having the lowest priority of treatment because of its indolent nature and low tumor burden. We performed laparoscopic-assisted sigmoid colectomy, followed by gallbladder bed resection on the same day. Unpredictably, gallbladder lesions were histologically revealed to be FL. Often, FL involves extranodal sites such as the gastrointestinal tracts. However, the gallbladder involvement is extremely rare, and preoperative distinction from gallbladder adenocarcinoma remains challenging to date; this report discusses its characteristics along with the literature review. Furthermore, our case, in which another malignant neoplasm coexisted, needed histological identification of the gallbladder lesions to ascertain the therapeutic strategy.
Subject(s)
Gallbladder Neoplasms , Lymphoma, Follicular/diagnosis , Aged , Biopsy , Diagnosis, Differential , Female , Humans , Positron Emission Tomography Computed TomographySubject(s)
Argon Plasma Coagulation/methods , Catheterization/adverse effects , Double-Balloon Enteroscopy/methods , Embolization, Therapeutic/adverse effects , Esophageal and Gastric Varices/therapy , Foreign-Body Migration/surgery , Jejunum/injuries , Aged , Device Removal/methods , Female , Foreign-Body Migration/diagnosis , Foreign-Body Migration/etiology , Humans , Liver , Syndrome , Tomography, X-Ray ComputedABSTRACT
A 76-year-old woman underwent a total gastrectomy with dissection of second group of lymph nodes for type 2 gastric cancer at the back wall of the middle stomach body. The gastric cancer was moderately differentiated adenocarcinoma, which involved the second group of lymph nodes. Tumor makers increased-the CEA level became 10.7 ng/mL and the CA19-9 level became 110 U/mL after the operation. CT scan showed a solitary splenic tumor sized about 60 mm in diameter. No other prominent metastatic lesions were demonstrated, so that a splenectomy was performed in February 2008. Histopathologically the splenic tumor was adenocarcinoma, and was diagnosed as metastasis of gastric cancer. The report which excised asynchronism spleen metastasis of a stomach cancer after the operation is very rare. She remains recurrence free 4 months later.
