title: Spontaneous perforation of primary gastric malignant lymphoma: a case report and review of the literature.
abstract: OBJECTIVE
  Spontaneous gastric perforation in the absence of chemotherapy is extremely rare. The authors encountered a case of spontaneous perforation of primary gastric lymphoma.
  
  
  METHODS
  A 58-year-old man visited the authors' hospital with acute severe epigastralgia. A large amount of free gas and a fluid collection around the stomach were noted on an abdominal computed tomography scan. The results of imaging studies indicated a perforated gastric ulcer, and a distal gastrectomy was performed. There was a large perforation about 50 mm in diameter in the anterior wall of the middle part of the stomach body. Microscopically, the full thickness of the gastric wall was diffusely infiltrated by a population of large atypical lymphoid cells. The lymphoid nature of these cells was indicated by the strongly positive immunohistochemical staining for CD20 and CD10. This confirmed the diagnosis of a germinal center B-cell-like type of diffuse large B cell lymphoma. Rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone were administered after the operation.
  
  
  CONCLUSIONS
  Gastrectomy should be considered if a giant ulcer with necrotic matter on the ulcer floor is seen on upper gastrointestinal endoscopy because of the possibility of gastric perforation. If upper gastrointestinal endoscopy shows a finding similar to the abovementioned one during chemotherapy, dose reduction of chemotherapy or gastrectomy should be considered.
authors.affiliation: Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan. yu.ohkura107@gmail.com.
authors.forename: Yu
authors.initials: Y
authors.lastname: Ohkura
authors.affiliation: Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan. s-lee@toranomon.gr.jp.
authors.forename: Seigi
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan. kazykazy613@yahoo.co.jp.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kaji
authors.affiliation: Department of Pathology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan. y-ota@yahoo.co.jp.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Ota
authors.affiliation: Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan. s-haruta@toranomon.gr.jp.
authors.forename: Shusuke
authors.initials: S
authors.lastname: Haruta
authors.affiliation: Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan. y-takeji@toranomon.gr.jp.
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Takeji
authors.affiliation: Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan. h-shinohara@toranomon.gr.jp.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Shinohara
authors.affiliation: Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan. m-ueno@toranomon.gr.jp.
authors.forename: Masaki
authors.initials: M
authors.lastname: Ueno
authors.affiliation: Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan. h-udagawa@toranomon.gr.jp.
authors.forename: Harushi
authors.initials: H
authors.lastname: Udagawa
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D006801:Humans; D007416:Intestinal Perforation / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D008228:Lymphoma, Non-Hodgkin / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013274:Stomach Neoplasms / Q000150:complications*