- 期刊
Combined Adenocarcinoma and Mucosaassociated Lymphoid Tissue Lymphoma in Atrophic Gastritis: A Case Report and Review of the Literature
萎縮性胃炎同時併存胃腺癌及粘膜相關淋巴組織淋巴瘤：病例報告及文獻回顧
摘要
萎縮性胃炎是指胃黏膜慢性發炎導致胃內的腺細胞減少，結果會影響到內在因子的分泌，造成維生素B12不足及巨幼細胞性貧血。萎縮性胃炎造成的原因包括幽門螺旋桿菌感染，而幽門螺旋桿菌本身也是被認為會導致胃的惡性腫瘤。一位過去身體健康的58歲女性最近感覺到全身疲累，頭暈及腹脹。血液檢查發現嚴重的貧血（血紅素：4.7g/dL，平均血球容積：123.7fL），白血球過低（白血球：1,900/uL）及血小板過低（血小板：32,000/uL）。另外她的維生素B12指數也是低下。上消化道胃鏡檢查診斷萎縮性胃炎。後來她接受全胃切除手術，原因是胃鏡的切片檢查給果是胃腺癌。全胃切除的病理報告是胃腺癌及粘膜相關淋巴組織淋巴瘤。病人後來接受維生素B12的補給，她全血球減少症也獲得改善。對於巨幼細胞性貧血，萎縮性胃炎必須列入鑑別診斷，另外它轉移成惡性腫瘤的潛在性也必須要注意。
關鍵字
無資料並列摘要
Atrophic gastritis is the process of chronic inflammation of the stomach mucosa that leads to the loss of gastric glandular cells. As a result, the stomach's secretion of intrinsic factor is impaired, leading to vitamin B12 deficiency and megaloblastic anemia. Atrophic gastritis can be caused by persistent infection with Helicobacter pylori, which is believed to be a risk factor for gastric malignancy. A previously healthy 58-year-old woman gradually developed general malaise with dizziness and a feeling of abdominal fullness. A hemogram confirmed severe anemia (hemoglobin, 4.7g/dL; mean corpuscular volume, 123.7fL), leukopenia (white blood cells, 1,900/uL), and thrombocytopenia (platelets, 32,000/uL). Her vitamin B12 level was low. Upper gastrointestinal endoscopy revealed a pale and thin mucosa in the antrum and corpus with loss of gastric rugae over the cardia, compatible with an atrophic gastritis diagnosis. We performed randomized biopsies over the stomach. The patient underwent surgical intervention for an adenocarcinoma that was identified on the gastric biopsy, and pathological examination revealed combined adenocarcinoma and mucosa-associated lymphoid tissue lymphoma. After vitamin B12 replacement, the pancytopenia improved. We believe that physicians should be aware of this clinical presentation of atrophic gastritis and not neglect its potential malignant transformation in daily practice.
延伸閱讀
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