SYNCHRONOUS MUCOSA-ASSOCIATED LYMPHOID-TISSUE LYMPHOMA AND ADENOCARCINOMA OF THE STOMACH

The development of simultaneous primary gastric lymphoma and carcinoma is a rare event for which a possible etiopathogenetic role for Helico bacter pylori (HP) recently has been postulated. We report a series of eight such cases diagnosed from 1980 to 1995. In two cases, both tumo rs arose in a gastric stump, at 26 and 34 years, respectively, after g astric resection for a duodenal ulcer. Grossly, the lymphoma and carci noma formed a single lesion in four cases (collision tumor); they were separated in the other four cases. Histologically, all the lymphomas fit into the category of B-cell mucosa-associated lymphoid tissue lymp homa; six of them were low-grade lymphomas and two were low-grade lymp homas with a high-grade component. The adenocarcinomas were intestinal -type in four cases, diffuse in three, and mixed in one. Regarding the depth of infiltration, four carcinomas were early gastric cancers and four were advanced. All the collision tumors contained an early gastr ic cancer. Our observations confirmed the association of HP with gastr ic lymphoma and carcinoma in 4 cases. Spiral bacteria with the feature s of Helicobacter heilmannii were found in one case. The occurrence of two different tumors in a gastric stump, which has not been reported previously, suggests that postgastrectomy gastritis might contribute t o the development of both gastric lymphoma and carcinoma.