Large gastrosplenic fistula after effective treatment of abdominal diffuse large-B-cell lymphoma.

摘要: Dear Editor, The monoclonal antibody rituximab, which binds to the CD20 antigen expressed on normal B cells and malignant of more than 90% diffuse, large B-cell lymphomas demonstrated its efficacy as a single agent or in combination with chemotherapy (e.g., CHOP) without adding relevant toxicity [1]. Its potent CHOP, together favorable profile, establishes rituximab an important part modern standard immunochemotherapy lymphomas. However, potency combined treatment regime may cause severe side effects case infiltration gastric wall described our case. A 56-year-old man suffering from general weakness, obstipation, weight loss 18 kg previous 3 months was admitted hospital rule out cancer. patient denied having any other symptoms fever sweating), recently performed colonoscopy unremarkable. On initial abdominal sonography, mass, 15 cm diameter, detected upper left quadrant. Subsequent computed tomography (CT) verified presence tumor that infiltrated spleen had direct contact stomach. Although assumed, it could not be by CT (Fig. 1). No manifestations were found; peripheral lymph nodes unremarkable, no pathologic findings noted bone marrow biopsy chest CT. Finally, CT-guided led diagnosis diffuse lymphoma (stage IIBE, IPI1). then treated according R-CHOP 21 regimen [2]. Several days after end third cycle, presented signs acute infection. Follow-up showed complete remission resulted opening stomach 2). referred surgery underwent splenectomy resection greater curvature Histopathologic analysis revealed splenic parenchyma tissue necrotic areas but only avital found. recovered well, discharged day 12 surgery, received remaining cycles chemotherapy. Gastrosplenic fistula resulting lesion is rare entity. Gastric adenocarcinoma, Crohn’s disease, benign ulcer, are known causes [3]. For gastrosplenic develop lymphoma, invasion required. If most even all layers infiltrated, rapid necrosis result formation adjacent [4]. In this context, five cases occurring have been reported [5], them describing quite small fistula. if larger possible for arise, Ann Hematol (2008) 87:337–338 DOI 10.1007/s00277-007-0404-5