When malignancy hits twice – synchronous gastric carcinoma and non-Hodgkin-B-cell lymphoma in a patient with common variable immunodeficiency

Abstract

Patients with common variable immunodeficiency (CVID) generally bear a higher risk of non Hodgkin B-cell lymphomas and solid tumors, in particular gastric adenocarcinoma.

Here we report a case of a 58-year-old male CVID patient who developed both malignancies within a very short period, as documented by two subsequent esophagogastroduodenoscopies performed within 4 months. While the first upper gastrointestinal endoscopy for routine surveillance purposes was uneventful, the second one after developing unexplained weight loss revealed two new neoplastic lesions in the stomach. The histological evaluation revealed a poorly differentiated adenocarcinoma infiltrating the muscularis propria forcing gastrectomy as well as a high-grade B-non-Hodgkin-lymphoma with detection of a MYC- and BCL6-translocation, necessitating chemotherapy with R-CHOP.

This case emphasizes the necessity of high awareness for gastric neoplasia in patients with CVID and highlights the need of a standardized yet not established endoscopic surveillance protocol for this vulnerable group.

Zusammenfassung

Patienten mit „Common Variable Immunodeficiency“ (CVID) weisen ein erhöhtes Risiko für Non-Hodgkin-B-Zell-Lymphome und solide Tumore, insbesondere Adenokarzinome des Magens, auf.

Hier berichten wir über einen Fall eines 58-jährigen männlichen CVID-Patienten, der beide Malignome innerhalb eines sehr kurzen Zeitraums entwickelte, wie durch 2 aufeinanderfolgende Ösophagogastroduodenoskopien dokumentiert wurde, die innerhalb von 4 Monaten durchgeführt wurden. Während die erste Endoskopie des oberen Gastrointestinaltrakts für routinemäßige Überwachungszwecke ereignislos verlief, zeigte die zweite, die nach Auftreten eines ungeklärten Gewichtsverlusts durchgeführt wurde, 2 neue neoplastische Läsionen im Magen. Die histologische Untersuchung ergab ein schlecht differenziertes Adenokarzinom mit Infiltration der Muscularis propria, was eine Gastrektomie erzwang, sowie ein hochgradiges B-Non-Hodgkin-Lymphom mit Nachweis einer MYC- und BCL6-Translokation, welches eine Chemotherapie mit R-CHOP erforderlich machte.

Dieser Fall demonstriert das hohe Risiko von Magenneoplasien bei Patienten mit CVID und unterstreicht die Notwendigkeit eines standardisierten, aber noch nicht etablierten endoskopischen Überwachungsprotokolls für diese anfällige Patientengruppe.

Schlüsselwörter

Magenkarzinom - Magenlymphom - Helicobacter pylori - CVID

Keywords

Gastric adenocarcinoma - Gastric lymphoma - Helicobacter pylori - CVID

Publication History

Received: 13 June 2022

Accepted: 27 June 2022

Article published online:
22 November 2022

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