Primary gastric Hodgkin's lymphoma.
BACKGROUND
Primary Hodgkin's disease of the stomach is an extremely rare entity. Nearly all cases of primary gastric lymphoma are of the non-Hodgkin's variety. Diagnoses in such cases are difficult due to considerable histological similarities between the 2 disease entities.


METHODS
We report the case of a 77 year old lady with a 1 year history of weight loss and poor appetite. Physical examination was unremarkable. Subsequent multiple upper GI endoscopies revealed a large malignant looking ulcer which was deemed to be histologically benign. Following CT imaging the patient underwent a radical gastrectomy. Postoperatively histology and immunohistochemistry failed to confirm a diagnosis. As such a second opinion was sought. Employing an extended array of immunohistological staining a diagnosis of 'Classical Hodgkin's' disease of the stomach was achieved.


CONCLUSIONS
Our case illustrates the significant difficulties in achieving a rare diagnosis of primary Hodgkin's lymphoma of the stomach. The non-specific nature of symptoms and a lack of histological features make a preoperative diagnosis extremely difficult. While immunohistochemistry is widely employed in aiding the evaluation of such cases, one should be wary of the considerable overlap in differentiating between Hodgkin's and non-Hodgkin's disease entities using this technique.
Hossain
Fahad S
FS
Department of Surgery, Queen Mary's Sidcup Hospital, Frognal Avenue, Sidcup, Kent, DA14 6LT, UK. f.hossain@doctors.org.uk
Koak
Yashwant
Y
Khan
Farrukh H
FH
D000368:Aged; D001707:Biopsy, Needle; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods; D005773:Gastroscopy / Q000379:methods; D006689:Hodgkin Disease / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D007813:Laparotomy / Q000379:methods; D018570:Risk Assessment; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D013276:Stomach Ulcer / Q000175:diagnosis*