Metachronous gastric adenocarcinoma following gastric lymphoma treated with chemotherapy and radiation therapy
DOI:
https://doi.org/10.24265/horizmed.2025.v25n1.16Keywords:
Lymphoma, Adenocarcinoma , Stomach Neoplasms , Neoplasms, Second PrimaryAbstract
Gastric cancer ranks fifth in both incidence and mortality worldwide, according to the report from
the Global Cancer Observatory (Globocan) as of 2022 (1). When discussing the global gastric cancer
report, it is assumed that it refers to adenocarcinoma. However, it should be pointed out that the
most frequent histological types of gastric cancer are adenocarcinoma and lymphoma, the former
being the most frequent on average, accounting for over 95 % of all gastric neoplasms (2). In Peru, the
Lima Metropolitan Cancer Registry ranked gastric cancer as the third most frequent and the leading
cause of mortality for both sexes (3). On the other hand, the synchronous or metachronous diagnosis
of these types of gastric cancer, such as adenocarcinoma and lymphoma, is rare. Metachronous
cancer, or second primary cancer, is defined as a new tumor that occurs more than six months after
the diagnosis of the first neoplasm, but is not caused by the dissemination or recurrence of the
previous tumor (4). For these reasons, and pertinently, we present the case report of a 57-year-old
female patient diagnosed with primary gastric lymphoma, treated with a combination of radiation
therapy and chemotherapy with curative intent. Thirteen years later, at the age of 70, she was
diagnosed with gastric adenocarcinoma during a follow-up endoscopy, which was managed surgically.
The case is detailed below, along with a review of the relevant literature.
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References
Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et
al. Global cancer statistics 2022: GLOBOCAN estimates of incidence
and mortality worldwide for 36 cancers in 185 countries. CA Cancer J
Clin [Internet]. 2024;74(3):229-63.
Hamaloglu E, Topaloglu S, Ozdemir A, Ozenc A. Synchronous and
metachronous occurrence of gastric adenocarcinoma and gastric
lymphoma: A review of the literature. World J Gastroenterol
[Internet]. 2006;12(22):3564-74.
Ministerio de Salud. Análisis de la situación de cáncer en el Perú 2013
[Internet]. Lima: MINSA; 2013. Disponible en: https://sinia.minam.
gob.pe/sites/default/files/sinia/archivos/public/docs/4279.pdf
Dorland N. Diccionario Medico Ilustrado. 6a ed. España: MCGRAW
HILL; 2003.
Ruiz E, Barreda F, Celis J, Payet E, Berrospi F. Cáncer Gástrico:
Historia Natural Diagnóstico y Resultados de Tratamiento. INEN 1950
–1999 [Internet]. Lima: INEN; 2013. Disponible en: https://www.
inen.sld.pe/portal/documentos/pdf/educacion/091115_NM%20
G%C3%A1strico%20Hp%20Salud%20Publica%2006-11-15.pdf
Buján Murillo S, Bolaños Umaña S, Mora Membreño K, Bolaños Martínez
Isabel. Carcinoma gástrico: revisión bibliográfica. Med leg Costa Rica
[Internet]. 2020;37(1):62-73.
Ruan X, Huang D, Zhan Y, Huang J, Ng AT, Tsu JH, et al. Risk of second
primary cancers after a diagnosis of first primary cancer: A pan-cancer
analysis and Mendelian randomization study. Elife [Internet].
;12:e86379.
Global Cancer Observatory: Cancer Today [Internet]. 2024.
Available from: https://gco.iarc.fr/today/en/dataviz/
tables?mode=population&cancers=7.
Violeta Filip P, Cuciureanu D, Sorina Diaconu L, Maria Vladareanu A,
Silvia Pop C. MALT lymphoma: epidemiology, clinical diagnosis and
treatment. J Med Life. 2018;11(3):187-93.
Juárez-Salcedo LM, Sokol L, Chavez JC, Dalia S. Primary Gastric
Lymphoma, Epidemiology, Clinical Diagnosis, and Treatment. Cancer
Control. 2018;25(1):1073274818778256.
Barreda Bolaños F, Gómez P R, Quispe L D, Sánchez L J, Combe
G J, Casanova M L, et al. Linfoma Gástrico Primario. Revista
Gastroenterologia Peru. 2004;24(3):238-62.
Morais S, Antunes L, Bento MJ, Lunet N. Second primary gastric
cancers in a region with an overall high risk of gastric cancer. Gaceta
Sanitaria. 2020;34:393-8.
Capelle LG, de Vries AC, Looman CW, Casparie MK, Boot H, Meijer GA,
et al. Gastric MALT lymphoma: epidemiology and high adenocarcinoma
risk in a nation-wide study. Eur J Cancer. 2008;44(16):2470-6.
Feng Y, Duan TJ, Huang Q, Li ZY, Liu YP, Luo MS, et al. The
clinicopathological characteristics of gastric cancer and precancerous
conditions in gastric DLBCL and MALT lymphoma patients: a
multi-center retrospective study. Ann Med. 2023;55(1):2193423.
Inaba K, Kushima R, Murakami N, Kuroda Y, Harada K, Kitaguchi M,
et al. Increased risk of gastric adenocarcinoma after treatment
of primary gastric diffuse large B-cell lymphoma. BMC Cancer.
;13:499.
Palmela C, Fonseca C, Faria R, Baptista RB, Ribeiro S, Ferreira AO.
Increased risk for metachronous gastric adenocarcinoma following
gastric MALT lymphoma-A US population-based study. United European
Gastroenterol J. 2017;5(4):473-8.
Baron BW, Bitter MA, Baron JM, Bostwick DG. Gastric adenocarcinoma
after gastric lymphoma. Cancer. 1987;60(8):1876-82.
Zorlu AF, Atahan IL, Gedikoglu G, Ruacan S, Sayek I, Tekuzman G.
Does gastric adenocarcinoma develop after the treatment of gastric
lymphoma? J Surg Oncol. 1993;54(2):126-31.
Saito M, Masutani M, Mabe K, Izumiyama K, Mori A, Irie T, et al.
Regression of gastric de novo diffuse large B-cell lymphoma following
Helicobacter pylori eradication: a case report. Acta Gastroenterol
Belg. 2016;79(3):367-9.
Butte JM, Torres J, Duarte I, Guzmán S, Llanos O. [Gastric
adenocarcinoma appearing 32 years after the resection of a gastric
lymphoma. Report of one case]. Rev Med Chil. 2008;136(10):1317-20.
Zullo A, Rago A, Felici S, Licci S, Ridola L, Caravita di Toritto T.
Onset and Progression of Precancerous Lesions on Gastric Mucosa of
Patients Treated for Gastric Lymphoma. J Gastrointestin Liver Dis.
;29(1):27-31.
Bahri M BSH, Boudawara T, et al. Second Gastric Cancer
After the Treatment of Primary Stomach Diffuse Large B-Cell
Lymphoma Colorectal Cancer: Open Access. 2017;3(1).
Sakr R, Massoud M, Aftimos G, Chahine G. Gastric Adenocarcinoma
Secondary to Primary Gastric Diffuse Large B-cell Lymphoma. J
Gastric Cancer. 2017;17(2):180-5.
Abreu MT, Peek RM, Jr. Gastrointestinal malignancy and the
microbiome. Gastroenterology. 2014;146(6):1534-46.e3.
Ramírez Ramos A, Sánchez Sánchez R. Helicobacter pylori 25 años
después (1983-2008): epidemiología, microbiología, patogenia,
diagnóstico y tratamiento. Revista de Gastroenterología del Perú.
;29:158-70.
van den Belt-Dusebout AW, Aleman BM, Besseling G, de Bruin ML,
Hauptmann M, van ‘t Veer MB, et al. Roles of radiation dose and
chemotherapy in the etiology of stomach cancer as a second
malignancy. Int J Radiat Oncol Biol Phys. 2009;75(5):1420-9.
Morton LM, Onel K, Curtis RE, Hungate EA, Armstrong GT. The rising
incidence of second cancers: patterns of occurrence and identification
of risk factors for children and adults. Am Soc Clin Oncol Educ Book.
:e57-67.
Khanna L, Prasad SR, Yedururi S, Parameswaran AM, Marcal LP,
Sandrasegaran K, et al. Second Malignancies after Radiation Therapy:
Update on Pathogenesis and Cross-sectional Imaging Findings.
Radiographics. 2021;41(3):876-94.
Azzam EI, Jay-Gerin JP, Pain D. Ionizing radiation-induced metabolic
oxidative stress and prolonged cell injury. Cancer Lett. 2012;327(1-2):
-60.
Cahan WG, Woodard HQ, Higinbotham NL, Stewart FW, Coley BL.
Sarcoma arising in irradiated bone: report of eleven cases. 1948.
Cancer. 1998;82(1):8-34.
Murray EM, Werner D, Greeff EA, Taylor DA. Postradiation sarcomas:
cases and a literature review. Int J Radiat Oncol Biol Phys.
;45(4):951-61.
Doyen J, Courdi A, Gérard JP. [Second primitive malignant neoplasm
after radiotherapy]. Cancer Radiother. 2010;14(4-5):255-62.
Yu Z, Xu C, Song B, Zhang S, Chen C, Li C, et al. Tissue fibrosis induced
by radiotherapy: current understanding of the molecular mechanisms,
diagnosis and therapeutic advances. Journal of Translational
Medicine. 2023;21(1):708.
Fijardo M, Kwan JYY, Bissey PA, Citrin DE, Yip KW, Liu FF. The clinical
manifestations and molecular pathogenesis of radiation fibrosis.
EBioMedicine. 2024;103:105089.
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