Z Gastroenterol 2009; 47 - A92
DOI: 10.1055/s-0029-1224071

Non-Hodgkin-malt lymphoma of lumg with systemic dissemination in the stomach and gallbladder accompanied by adenocarcinoma of the urinary bladder and the pancreas

E Szaleczky 1, L Tóth 2, E Tóth 3, Á Pap 4
  • 1Int. Med. Dept. A, National Institute of Oncology, Budapest
  • 2Surgery, National Institute of Oncology, Budapest
  • 3Oncopathology, National Institute of Oncology, Budapest
  • 4Gastroenterology/Endoscopy, National Institute of Oncology, Budapest

Treatment of non-Hodgkin MALT lymphoma is highly effective but relapse of the disease with systemic dissemination can occur even after decades. Also solid tumors of different organs can be manifested during the long follow-up necessary for prevention of relapses. Etilogical role of chemotherapy used to prevent relapses and systemic dissemination of lymphoma cannont be denided in these secondary malignancies. A 66 years old male patient undervent left pulmonary upper lobe resection for non-Hodgkin MALT lymphoma 19 years ago. Repeated chemotherapeutic protocols were used between 1993–2004 to prevent relapses. CVP: Cyclophosphamide, Vincristine, Prednisone; CHOP: Cyclophosphamide,

Adriamycine, Vincristine, Prednisone; CAMP: Lomustine, Cytosine arabinoside, Mitoxantrone, Prednisone.

In 2007 a TUR followed by partial resection of the bladder trigonum was performed. Systemic dissemination of the lymphoma occurred in the stomach and lung. Gemcytabine +Vinorelbine therapy resulted in pulmonary toxicity thus a VIM: Etoposide, Ifosfamide, Mitoxantrone protocol was administered in 3 cycles. Jaundice indicated biliary obstruction with a 2cms pancreatic mass in the head first supposed as dissemination of lymphoma but bush cytology did not confirmed the diagnosis at that time. Uncovered self expandable metal stent (SEMS) resolved the jaundice and Thalidomide treatment then CEPP: Carbomustine, Etoposide, Prednisone, Procarbasine protocol was initiated but inflammatary changes of the gallbladder and the abdominal space necessitated cholecystectomy. Histology demonstrated dissemination of MALT lymphoma of the gallblader. Repeated brush cytology of the stented common bile duct finally confirmed the pancreatic cancer supposed by ERCP earlier. The covered SEMS definitively resolved the relapsing jaundice.

Conclusion: success of chemotherapy of MALT lymphoma can give a long way to further carcinogenesis.