CASE LÂM SÀNG: UNG THƯ DẠ DÀY HAI VỊ TRÍ, BA LOẠI TẾ BÀO

Abstract

Background: In the literature, there are 5 cases of gastric adenocarcinoma with diffuse large B-cell non-Hodgkin lymphoma, but there have been no reports of a case of large cell neuroendocrine carcinoma combined with the above two cell types in the same organ. Case: A 78-year-old male patient was admitted to the hospital because of melena and protrusion in the anal canal during defecation. Clinically there is pale skin, mixed hemorrhoids grade III. Gastroscopy to screen for other causes of anemia: 3cm from the cardial angle on greater curvature, 10*8cm, high, hard edges, pseudomembranous ulcerated bottom, 3*4cm lesions on the lesser curvature, hard margin easy to bleed. Biopsy results of adenocarcinoma. The patient underwent laparoscopic total gastrectomy, and D2+ lymph node dissection, and was discharged after 10 days of surgery without complications. Immunohistochemistry: upper lesions diffuse large B-cell non-Hodgkin lymphoma, lower lesions moderately differentiated adenocarcinoma. After 1 course of chemotherapy with TS-1 regimen, the patient was diagnosed with hospital-acquired pneumonia and died 5 months after surgery. Conclusion: Low gastrointestinal bleeding due to hemorrhoids is common, sometimes confused with gastrointestinal cancers that need to be carefully examined, gastric cancer with 3 cell types, and 2 locations, is very rare, and needs coordinated treatment of many specialties.