A 48-year-old male patient, heart transplanted for seven years, presented with epigastric discomfort after ingestion and postprandial fullness.
A gastroscopy showed a large tumor in the gastric antrum that extended the light, samples were taken for biopsy and determination of helicobacter pylorii (H. pylorii).
The pathological study revealed a lymphoproliferative process
The rest of the complementary examinations provided the following data: 9800 leukocytes (72% neutrophils) Hb.
■ g/dl, platelets 349000/mm3, blood smears with mild anisopoycylocytosis, normal blood chemistry.
Plasma protein electrophoresis showed a normal immunoglobulin pattern, with no monoclonal peak, negative urine proteins, beta 2 microglobulin 1.5.
Radiological bone series was normal.
Polymorphous bone marrow biopsy showed no evidence of tumor involvement (plasma cells 1-2%, lymphoid series 10%).
Serology EBV: IgG positive in the pretransplant study.
Gammagraphy with negative gallium.
DSE showed a large gastric tumor and CAT-abdominal thickening of the gastric wall without masses or pathological adenopathies at any level.
The H. pylorii test was positive.
It was decided to perform an exploratory laparotomy, showing a large gastric antrum tumor located in the anterior aspect of the pancreas and transverse mesocolon up to the root of the mesentery.
It was considered unresectable and a gastroenterostomy and biopsy were performed.
The histopathological study of surgical biopsies showed a lymphoproliferative process that expanded the mucosa with glandular loss and disruption of the muscular layer.
Proliferation was constituted by cells with morphological characteristics similar to plasma cells, with Dutcher and Russell inclusions of CD20-Kappa immunophenotype.
Latent EBV membrane protein (LMP-1) was positive.
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After the intervention, radiotherapy was not proposed because the toxicity generated in the irradiation field was unacceptable.
Ganvir IV was administered for 15 days and continued with antiretroviral therapy.
Amoxicillin was prescribed to treat H. pylori infection.
The dose of Cyclosporine and Prednisone was reduced and Aziatoprine was suspected by Mycophenolate Mofetil.
A reduction in the tumor mass was observed in the control gastroscopy performed in May of the same year.
The anatomopathological study of the biopsies reports a significant reduction of neutrophilic cells and the presence of a lymphoid clump.
Interferon is started at 1.5 million units every other day.
In the following months, the patient presents acute rejection episode established in the graft treated with methylprednisolone bolus for 3 days and subsequently increases the dose of Cyclosporine, although below the therapeutic range.
Five months after diagnosis, gastroscopy, biopsy and H. pylorii test were negative.
The dose of interferon was increased to 3 million units every other day due to good tolerance to treatment.
Subsequently, she presented another episode of heart failure and, when acute rejection was suspected, a cardiac biopsy confirmed it.
Corticosteroid therapy was started.
Death due to cardiac arrhythmia occurred on the second day of treatment.
The autopsy showed the morphological absence of gastric lymphoproliferative process and severe rejection of the heart graft.
