| Objective:To report a case of synchronous angioimmunoblastic T cell lymphoma and primary gastric cancer. So as to improve the diagnosis and treatment ability to the diseases.Methods:The clinical features, histopathologic characteristics, treatment and prognosis of one patient with synchronous angioimmunoblastic T cell lymphoma and primary gastric cancer was analyzed. The related literatures were reviewed.Results:A 74-year-old man was admitted to Shanxi Dayi Hospital with enlarged superficial lymph nodes, fever, skin and scleral yellow staining for 14 days. The patient had irregular fever with 38.5℃, Skin and scleral yellow staining, superficial lymph nodes were enlarged,a history of severe jaundice,double lung rales. His liver undered the costal margin for 7cm,which had tenacious quality, circled edge, no tenderness and friction. His spleen was mild enlargement. He had not only a high level of EBV-DNA copy in peripheral blood which reached 6.93x104copy/ml, blood lipid, Jaundice index and serum ferritin, but also low levels of fibrinogen. His blood routine test showed three reduction and abnormal high proportion of lymphocytes and liver function was poor. His bone marrow smear showed hemophagocytics were 3% and lymphoma cells were 30%. After radical gastrectomy for gastric cancer, his pathologypoorly was differentiated adenocarcinoma. His cervical lymph node puncture and inguinal lymph node biopsy of pathology were angioimmunoblastic Tcell lymphoma. He was definitely diagnosed as angioimmunoblastic T cell lymphoma with leukemia, hemophagocytic syndrome, gastric cancer and pulmonary infection. This elderly and poor physical fitness patients has severe pulmonary infection. After given methylprednisolone, ganciclovir, etoposide and gamma globulin, his pulmonary infection and the general situation improved significantly. Then after received recombinant human vascular endothelial inhibin(Endostatin), ganciclovir and COEP Regimen, the patient’s liver function and bilirubin reduced, EBV-DNA copy numbers was normal, systemic lymphadenopathy disappeared. The patient achieved complete response(CR)with survival for 6 months.Conclusions:AITL is a rare type of lymphoma and has no standard therapeutic regimen. After radical resection of gastric cancer should be treated with chemotherapy.angioimmunoblastic T cell lymphoma complicated with primary gastric cancer had no clear, unified, and efficient treatment options. Inhibition of angiogenesis and viral replication, combined with chemotherapy can be used as a new choice in synchronous AITL and primary gastric cancer. |
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