A CASE OF MALIGNANT LYMPHOMA OF THE STOMACH WITH INTRAORBITAL METASTASIS

A 69-year-old man was seen at the department because of epigastralgia on the left side and vomiting. Admixture of an ulcerative lesion and a torose lesion of the body of the stomach were observed by an endoscopy. The diagnosis of malignant lymphoma (diffuse large B cell type) was made based on a biopsy. Instead of preoperative chemotherapy as one of the choices of treatment a lapalotomy was performed with the aim of avoiding the risk of perforation of the ulcer legion. Direct invasion of the tumor into the pancreas, spleen and transverse mesocolon and widespread invasion around the left part of the diaphragm were observed. Therefore, the lesion was unresectable. The postoperative course was satisfactory, and THP-COP therapy was started. But headaches occurred at 38 postoperative day, and then blurred vision and dextral deviation of the right eye also occurred. Depression of the optic nerve by a tumor was observed in the ocular orbit by computerized tomography of the head; thus, metachoronous metastasis of the malignant gastric lymphoma to the intraorbital tissue was diagnosed. Steroid and radiation therapy at 26 Gy were administered. The symptoms were alleviated and also the tumors disappeared as observed by computerized tomography. Although intraorbital metastasis of malignant lymphoma has rarely been reported, we have experienced this case which showed a remarkable response to radiation therapy at the metastatic focus. When we consult the case of malignant gastric lymphoma, it is necessary to consider the metachronous onset in the general organs.