title: Situs inversus totalis with malignant lymphoma of the stomach: report of a case.
abstract: Situs inversus totalis is a rare congenital anomaly that often occurs concomitantly with other disorders. We report a case of situs inversus totalis with malignant lymphoma of the stomach, which was successfully treated by surgery followed by chemotherapy and irradiation. The patient was a 51-year-old woman who present with colicky pain in the left upper quadrant of her abdomen. Chest X-ray showed a right-sided heart, and ultrasonography and computed tomography (CT) of the abdomen showed a situs inversus totalis with multiple gallstones in the gallbladder. Tree-dimensional reconstructed CT of the abdomen showed no other malformations coexisting with situs inversus totalis, but a barium upper gastrointestinal series found an inverted stomach and an elevated tumor with ulceration in the center, localized in the antrum of the stomach. First, we performed a cholecystectomy, followed by a total gastrectomy with dissection of the lymph nodes and splenectomy, and Roux-en-Y reconstruction. Histopathological examination confirmed a diagnosis of malignant lymphoma of the stomach (diffuse large B-cell type) with metastasis to the regional lymph nodes. Chemotherapy using the CHOP regimen was given three times, starting 1 month postoperatively. A followup CT scan showed enlargement of one lymph node around the abdominal aorta and irradiation was delivered to the area of the inverted Y in the abdomen. At the time of writing, 10 months after surgery, the patient is well with no signs of recurrence and leading a normal life. Careful preoperative assessment is very important for determining the most appropriate surgical procedure in patients with situs inversus totalis associated with a malignancy.
mesh_terms: D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D016393:Lymphoma, B-Cell / Q000150:complications* / Q000601:surgery / Q000628:therapy; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications* / Q000601:surgery / Q000628:therapy; D008875:Middle Aged; D012857:Situs Inversus / Q000150:complications*; D013274:Stomach Neoplasms / Q000150:complications* / Q000601:surgery / Q000628:therapy; D014057:Tomography, X-Ray Computed