Phlegmonous gastritis developed during chemotherapy for acute lymphocytic leukemia:A case report

BACKGROUND Phlegmonous gastritis(PG)is a rare bacterial infectious disease characterized by neutrophil-based purulent inflammation of the gastric wall.The most representative causative bacterium is Streptococcus pyogenes,followed by Staphylococcus,Pneumococcus and Enterococcus.Hepatic portal venous gas(HPVG)is considered a potentially fatal condition and is rarely associated with PG.CASE SUMMARY The white blood cell count of a 70-year-old woman with acute lymphocytic leukemia in complete remission dropped to 100/μL after consolidation chemotherapy.Her vital signs were consistent with septic shock.Venous blood culture revealed the presence of Bacillus cereus.Abdominal computed tomography(CT)and esophagogastroduodenoscopy(EGD)showed marked thickening of the gastric wall.As with the other findings,CT was suggestive of HPVG,and EGD showed pseudomembrane-like tissue covering the superficial mucosa.Histopathological examination of gastric biopsy specimens showed mostly necrotic tissue with lymphocytes rather than neutrophils.Culture of gastric specimens revealed the presence of Bacillus cereus.We finally diagnosed this case as PG with Bacillus cereus-induced sepsis and HPVG.This patient recovered successfully with conservative treatment,chiefly by using carbapenem antibiotics.CONCLUSION The histopathological finding of this gastric biopsy specimen should be called"neutropenic necrotizing gastritis".

ALK-positive anaplastic large cell lymphoma presenting multiple lymphomatous polyposis: A case report and literature review

BACKGROUND Anaplastic large cell lymphoma(ALCL)is a type of T-cell lymphoma that can be divided into two categories:anaplastic lymphoma kinase-positive(ALK+)and ALK-negative.Gastrointestinal ALK+ALCL is rare.Multiple lymphomatous polyposis(MLP)is thought to be a representative form of gastrointestinal lesion in mantle cell lymphoma,and T-cell lymphomas seldom show this feature.Here,we report the first known case of ALK+ALCL with gastroduodenal involvement to present with MLP.CASE SUMMARY The patient was a 43-year-old man who was complained of a mass in the left inguinal area and was performed open biopsy.ALK+ALCL was diagnosed pathologically.Computed tomography scan demonstrated multiple lymph node lesions in the abdomen-pelvis/inguinal region,and scattered nodular lesions in both lung fields.He did not complain of gastrointestinal symptoms.While,esophagogastroduodenoscopy identified MLP lesions from the antrum of the stomach to the descending portion of the duodenum and mild thickened folds on the corpus of the stomach,and biopsy showed invasion of ALK+ALCL.We treated this patient with six cycles of CHOEP(Cyclophosphamide,Doxorubicin,Vincristine,Etoposide,and Prednisone)chemotherapy.At the conclusion of treatment,there was complete remission.Numerous white scars were found on the stomach,endoscopically consistent with a remission image of lymphoma.The endoscopic features of this case were thought to be similar to those of MCL.CONCLUSION The macroscopic/endoscopic features of gastrointestinal ALK+ALCL may be more similar to those of B-cell lymphomas rather than T-cell lymphomas.

Acquired hemophilia A in solid cancer: Two case reports and review of the literature

Acquired hemophilia A(AHA) is a rare, hemorrhagic autoimmune disease, whose pathogenesis involves reduced coagulation factor Ⅷ(FⅧ) activity related to the appearance of inhibitors against FⅧ. Common etiological factors include autoimmune diseases, malignancy, and pregnancy. We report two cases of AHA in solid cancer. The first case is a 63-year-old man who developed peritoneal and intestinal bleeding after gastrectomy for gastric cancer. He was diagnosed with AHA, and was treated with prednisone, followed by cyclophosphamide. In the second case, a 68-year-old man developed a subcutaneous hemorrhage. He was diagnosed with AHA in hepatocellular carcinoma on CT imaging, and treated with rituximab alone. Hemostasis was achieved for both patients without bypassing agents as the amount of inhibitors was reduced and eradicated. However, both patients died within 1 year due to cancer progression. Successful treatment for AHA in solid cancer can be difficult because treatment of the underlying malignancy is also required.

Non-Hodgkin’s lymphoma: A case of testis lymphoma metastasized to the gallbladder

Testis lymphoma (diffuse large B cell lymphoma) metastasized to the gallbladder. The gall bladder is rarely involved in cases of the malignant lymphoma, and lymphoma metastasis from the testis to the gallbladder has not been previously reported. These reports may possibly change by the introduction of PET/CT. Furthermore, although it was a struggle to diagnose this particular case, there is a possibility that we may have been able to recognize metastasis from the testis at an earlier stage if PET/CT had been conducted.