Successful treatment of a primary gastric T-cell lymphoma lacking the human T-cell leukemia virus type 1

Primary gastric lymphomas generally are of B-cell lineage. Among the previously reported cases of exceptional primary gastric T-cell lymphomas, most demonstrate evidence of human T-cell leukemia virus type 1 (HTLV-1) infection with a poor prognosis. The present study is a report of a rare case of primary gastric T-cell lymphoma without HTLV-1 which could be successfully treated with surgical resection and adjuvant chemotherapy. The patient was a 50-year-old Japanese male who presented with epigastric pain. Clinical examination showed no lymphadenopathy or skin changes. Radiographic and endoscopic examinations revealed an ill-demarcated ulcerative lesion in the stomach, and a biopsy specimen confirmed high-grade lymphoma. Total gastrectomy with regional lymph node dissection was performed. Histological examination of the gastric lesion revealed a malignant lymphoma, diffuse large cell type, with lymph nodal involvement. On immunohistochemistry, tumor cells were positive for CD3, CD4 and CD30, but negative for CD8, CD20 and CD56, implying a T-cell nature. Following surgery, the patient received 8 cycles of chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisolone/CHOP). To date the patient has been free of recurrence for 86 months without further treatment. Review of previously reported cases of primary gastric T-cell lymphoma indicates that the prognosis is better without than with HTLV-1. We conclude that primary gastric T-cell lymphomas without HTLV-1 should be managed in the same way as the more common diffuse large B-cell type gastric lymphomas.