Linfoma gástrico con perforación contenida por absceso con extensión endotorácica

espanolMujer de 46 anos que consulta por epigastralgia, hematemesis y melenas. Antecedente reciente de consumo de AINES (aintiiflamatorios no esteroideos). Se realiza endoscopia alta objetivando ulcera de aspecto excavado rodeada por pliegues engrosados que parece continuar con una cavidad e impresiona de perforacion. Se solicita tomografia computarizada toracoabdominal confirmando la perforacion, que esta contenida por absceso infradiafragmatico con signos de extension endotoracica. El estudio histologico de las biopsias gastricas concluye linfoma B difuso de celulas grandes fenotipo no centrogerminal y subtipo inmunoblastico. Los linfomas representan menos del 5% de los tumores del tracto gastrointestinal, afectando fundamentalmente al estomago. La perforacion gastrica ocurre ocasionalmente en pacientes en tratamiento con quimioterapia. Sin embargo, la perforacion espontanea es rara, y supone un factor de mal pronostico ademas de tener elevada mortalidad. EnglishA 46-year-old woman complains of epigastric pain, hematemesis, and melena. She had a recent history of NSAID (non-steroidal anti-inflammatory drugs) use due to costal pain. Upper digestive endoscopy shows an excavated ulcer surrounded by thickened folds. The ulcer seems to continue with a cavity with fibrin at the edges that impress of perforation. Due to the findings, thoracoabdominal computed tomography is performed. It confirms the perforation, which is contained by an infradiaphragmatic abscess with signs of endothoracic extension. Histological study of gastric biopsies concludes diffuse large B-cell lymphoma, immunoblastic subtype. Lymphomas account for less than 5% of tumors affecting the gastrointestinal tract, involving mainly the stomach. Gastric perforation sometimes occurs in patients receiving chemotherapy. However, spontaneous perforation is rare and it is a poor prognostic factor with high mortality.