title: Synchronous malignant B-cell lymphoma and gastric tubular adenocarcinoma associated with paraneoplastic cutaneous vasculitis: hypereosinophilic syndrome with mixed cryoglobulinemia is an important sign of paraneoplastic syndrome.
abstract: Gastric adenocarcinoma developing concomitantly with a lymphoma is rare. Furthermore, B-cell lymphoma, originating from lymph nodes, with eosinophilia is extremely rare. We report here a case with a synchronous diffuse large B-cell lymphoma (DLBCL) and an early adenocarcinoma of the stomach. In addition, this case seemed to be associated with paraneoplastic cutaneous vasculitis caused by hypereosinophilic syndrome (HES) with mixed cryoglobulinemia (MC). Many neoplastic diseases that affect internal organs display cutaneous manifestations, which may be the presenting signs and symptoms of the underlying malignancy. In particular, the association between cutaneous vasculitis and malignancy has been widely reviewed, and recently neoplasms have been suggested to produce antigens and the resultant immune complex formations, activating the serum complement, thus cause paraneoplastic vasculitis. In this case, severe eosinophilia and cryoglobulinemia with low complements were observed in a laboratory test. A biopsy specimen from a skin lesion revealed leukocytoclastic vasculitis with severe perivascular infiltration of eosinophils. The cutaneous vasuculitis was considered to be a manifestation of HES with MC, although there were no etiological factors of HES and MC. Therefore, the vasculitis seems to be a symptom of paraneoplastic syndrome in this case. Our finding suggests that the potential presence of malignancies should be kept in mind as a possible underlying disorder especially in the presence of HES with MC; this possibility is interesting also as regards at least part of the pathogenesis for paraneplastic syndrome.
authors.affiliation: Department of Internal Medicine and Rheumatology, Juntendo University Urayasu Hospital, Chiba, Japan;
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Nozawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kaneko
authors.forename: Tomoyasu
authors.initials: T
authors.lastname: Itoh
authors.forename: Yoko
authors.initials: Y
authors.lastname: Katsura
authors.forename: Masaaki
authors.initials: M
authors.lastname: Noguchi
authors.forename: Fujihiko
authors.initials: F
authors.lastname: Suzuki
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Takasaki
authors.forename: Hideoki
authors.initials: H
authors.lastname: Ogawa
authors.forename: Kenji
authors.initials: K
authors.lastname: Takamori
authors.forename: Iwao
authors.initials: I
authors.lastname: Sekigawa