Hemorrhagic Multiple Ulcers of the Intenstine Associated with Hematopoietic Malignancy, Report of Two Cases

Yuji Imamura, Takashi Yokoyama*, Hiroaki Tsumura, Yoshiaki Murakami, Hitoshi Sewake, Eizou Hiyama, Mikio Fujimoto, Yoshio Takesue, Takashi Kodama, Yuichiro Matsuura

The First Department of Surgery, *Department of General Medicine, Hiroshima University School of Medicine (Chairman: Prof. Yuichiro Matsuura)

We recently experienced two cases of multiple hemorrhagic ulcers of the intestine. They ware associated with hematopoietic malignancy and had interesting pathological fundings. Case 1. The patient was a young woman (10 y) in whom melena developed after chemotherapy for the leukemic changes of malignant lymphoma. Case 2. The patient was male (53 y) in whom bloody stool appeared with abdominal pain during the past two years in which refractory anemia with an excess of blasts was diagnosed and corticosteroids had been given. Both case massive bleeding had continued and necessitated surgical resection, but ulcers recurred. From the pathological study, in case 1 the ulcerative lesion have been made by invasions of malignant cells and cytomegalovirus. In case 2 we could detect only an infiltration of inflammatory cells around ulcers and the findings indicating nonspecific ulcers. In adition we could not detect an increase in neutrophils superoxide production by chemiluminescense during postoperative peroid, which is considered one of the host defense reactions to a surgical intervention, and he had a severe bacterial infection. These two cases suggested that not only an infiltration of atypical cells into the diementary tract but also bacterial and viral infections in a suppression of host defense which was induced by advanced hematopoietic diseases or iatrogenic factors, such as chemotherapy and steroid therapy, might cause hemorrhagic multiple ulcers.

Key words
hematopoietic malignancy, hemorrhagic multiple ulcers of the intestine, cytomegalovirus

Reprint requests
Yuji Imamura First Department of Surgery, Hiroshima University School of Medicine
1-2-3 Kasumi, Minami-ku, Hiroshima, 734 JAPAN

Accepted
May 9, 1990

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