Mucosa-associated lymphoma of the bladder with relapse in the stomach after successful local treatment

Abstract

A 64-year-old woman was referred to our hospital for management of an ovarian tumor. Abdominal computed tomography and magnetic resonance imaging revealed a dermatoid cyst of the ovary and a bladder tumor. Transurethral resection of the bladder tumor was performed. Histopathological examination of the tumor revealed non-Hodgkin's lymphoma of the mucosa-associated lymphoid tissue MALT type. The patient received radiotherapy for the bladder and had a complete response. Nineteen months later, gastrointestinal endosopy revealed the presence of a mass lesion in the stomach. Histopathological examination of biopsy specimens from this tumor indicated the same tumor as that in the bladder as they showed identical IgH gene rearrangement. Because of the detection of evidence of Helicobacter pylori (HP) infection in the gastric mucosal biopsy specimens, the patient was administered HP eradication therapy, but, the tumor persisted. After radiotherapy, the stomach tumor disappeared. Since then she remains without evidence of local recurrence or relapse.

患者は64歳, 女性。ドックで卵巣腫瘍を指摘された。画像検査で膀胱腫瘍を確認したため経尿道的膀胱腫瘍切除術を行った。病理組織学的検査はMALTリンパ腫であった。全身検索したが, 膀胱以外に腫瘍はなく, 膀胱に放射線療法を行った。19ヵ月後, 上部消化管検査で胃の粘膜に腫瘍が認められた。生検の結果MALTリンパ腫であり, 遺伝子再構築が認められ, 膀胱MALTリンパ腫と遺伝子学的に同一と考えられた。Helicobacter pyloriの感染があり, 除菌が行われたが腫瘍は縮小せず, 胃に放射線療法を行った。その後, 膀胱, 胃に再発は認められていない。(著者抄録)