Gastric lymphoepithelioma-like carcinoma is a rare carcinoma among gastric malignant tumor but has a good prognosis. The carcinoma has histologic feature characterized by small nest of cancer cells mixed with lymphoid stroma. We report a case with lymphoepithelioma-like carcinoma of stomach initially presenting as panperitonitis because of spontaneous tumor perforation. A 56-year-old man visited our emergency room because of epigastric pain. A preoperative abdominal CT scan showed a massive pneumoperitoneum in the upper abdomen, and the presence of gastric cancer in the lesser curvature of the stomach. An emergent laparotomy was performed followed by radical subtotal gastrectomy. Pathologic examination revealed that the tumor was a lymphoepithelioma-like gastric carcinoma.
Carcinoma/*diagnosis/pathology/therapy ; Combined Modality Therapy ; Humans ; Lymphoma/radiography/surgery ; Male ; Middle Aged ; Pneumoperitoneum/etiology/radiography/surgery ; Rupture, Spontaneous ; Stomach Neoplasms/*complications/*diagnosis/pathology/therapy ; Stomach Rupture/*complications/radiography/surgery ; Tomography, X-Ray Computed

Pneumoperitoneum, free intra-abdominal air, usually results from the perforation of a hollow viscous. In approximately 10% of cases, however, pneumoperitoneum is not caused by gastrointestinal perforation. These cases of "spontaneous pneumoperitoneum" generally follow more benign course and may not require surgical intervention. Examples include cardiopulmonary resuscitation (CPR), malrotation, mechanical ventilator support, gynecologic manipulation, blunt abdominal trauma, and chronic intestinal pseudoobstruction in infancy (Sieber syndrome). But, it is extremely rare of spontaneous pneumoperitoneum secondary to idiopathic intestinal pseudoobstuction in adult. We herein report a patient with chronic idiopathic intestinal pseudoobstuction who developed a pneumoperitoneum.
Adult ; Chronic Disease ; Humans ; Intestinal Pseudo-Obstruction/complications/*diagnosis/surgery ; Intestine, Small/pathology ; Male ; Pneumoperitoneum/*diagnosis/etiology/radiography ; Tomography, X-Ray Computed