The final pathology showed poorly differentiated adenocarcinoma with negative proximal and distal margins, but with transmural extension to the liver capsule and seven positive omental lymph nodes.
Surgeon: William Lynch
Chief Resident: Subrato Deb
Comment: Patients who have had abdominal radiation for Hodgkin's lymphoma (typically 4,400 rad) have a ten-fold risk of developing a secondary malignancy, usually of the stomach. Radiation induced gastric
carcinoma typically presents 10-15 years post therapy with symptoms of dyspepsia and gastric outlet obstruction. Because these patients are usually young, gastric cancer might not be high in the differential, resulting in a delay in diagnosis. Aggressive work up of patients with a history of radiation is essential. Even with prompt attention, as in this classic case, the disease may have already spread. Treatment options are limited both because adenocarcinoma is not particularly
radiosensitive and would require high doses, and the limited tissue tolerance due to the prior radiation would preclude such therapy. The chest mantle component of radiation therapy for Hodgkins similarly raises the risk of breast cancer at 10-15 years. Increased surveillance
is important in both groups, but guidelines are not clearly established.
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