RESUMO
El Linfoma no Hodgkin (LNH) extraganglionar es una neoplasia maligna que corresponde al 40% de los casos de LNH, siendo el tracto gastrointestintal (TGI) la localización más común. Dentro del TGI es el estómago el órgano más afectado (60%). Presentamos el caso de un hombre de 52 años trabajador en empresa minera por más de 10 años, el cual es derivado al Servicio de Gastroenterología por presentar un cuadro de epigastralgia, náuseas y baja de peso. La endoscopía digestiva mostró una lesión ulcerada en cuerpo gástrico a la cual se le tomaron múltiples biopsias. El estudio histológico y el posterior análisis inmunohistoquímico permitieron realizar el diagnóstico de LNH B difuso de células grandes. Asimismo, el paciente presentó compromiso de múltiples órganos en relación a exposición crónica de metales pesados, lo cual fue comprobado en el mineralograma, siendo las de mayor concentración el uranio, talio, arsénico, plomo y mercurio. En la literatura se ha descrito la asociación de exposición laboral crónica a Uranio y Arsénico con la presentación de LNH de compromiso gastrointestinal. Por tal motivo, el compromiso gástrico no se puede considerar como un daño aislado, sino más bien parte del compromiso sistémico asociado a concentraciones elevadas de metales. La minería constituye el principal motor de ingresos económicos para el Perú, sin embargo, no existen reportes hasta la fecha de la asociación de LNH de compromiso gastrointestinal en relación a exposición laboral a metales pesados.
Primary extranodal Non-Hodgkin lymphoma (NHL) is a non epithelial tumours that accounts for 40% of cases of NHL. Spread of nodal lymphomas to the gastrointestinal tract (GIT) is the most common location. Within the GIT is the stomach the most affected organ (60%). We report the case of 52-year- old man, mining company worker for over 10 years, which is derived to the Service of Gastroenterology with history of epigastric pain, nausea, vomiting and weight loss. Upper gastrointestinal endoscopic examination revealed an ulcerated lesion on greater curve of stomach and histopathological examination and subsequent immunohistochemical analysis showed diffuse large B cell gastric NHL. Also, the patient had multiple organ involvement in relation to chronic exposure to heavy metals, which was found in the mineralograma, with the highest concentration of uranium, thallium, arsenic, lead and mercury. The literature has described the association of chronic occupational exposure to uranium and arsenic with NHL presenting gastrointestinal involvement. Therefore, gastric commitment can not be considered as an isolated injury, but rather part of systemic involvement associated with elevated concentrations of metals. Mining is a key driver of income for Peru; however, there are no reports to date of the association of gastrointestinal NHL commitment regarding occupational exposure to heavy metals.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Carcinógenos Ambientais/efeitos adversos , Linfoma Difuso de Grandes Células B/diagnóstico , Metais Pesados/efeitos adversos , Doenças Profissionais/diagnóstico , Exposição Ocupacional/efeitos adversos , Neoplasias Gástricas/diagnóstico , Linfoma Difuso de Grandes Células B/induzido quimicamente , Mineração , Doenças Profissionais/induzido quimicamente , Neoplasias Gástricas/induzido quimicamenteRESUMO
Primary extranodal Non-Hodgkin lymphoma (NHL) is a non epithelial tumours that accounts for 40% of cases of NHL. Spread of nodal lymphomas to the gastrointestinal tract (GIT) is the most common location. Within the GIT is the stomach the most affected organ (60%). We report the case of 52-year- old man , mining company worker for over 10 years, which is derived to the Service of Gastroenterology with history of epigastric pain, nausea, vomiting and weight loss. Upper gastrointestinal endoscopic examination revealed an ulcerated lesion on greater curve of stomach and histopathological examination and subsequent immunohistochemical analysis showed diffuse large B cell gastric NHL. Also, the patient had multiple organ involvement in relation to chronic exposure to heavy metals, which was found in the mineralograma, with the highest concentration of uranium, thallium, arsenic, lead and mercury. The literature has described the association of chronic occupational exposure to uranium and arsenic with NHL presenting gastrointestinal involvement. Therefore, gastric commitment can not be considered as an isolated injury, but rather part of systemic involvement associated with elevated concentrations of metals. Mining is a key driver of income for Peru; however, there are no reports to date of the association of gastrointestinal NHL commitment regarding occupational exposure to heavy metals.