II. Malignant Lymphoma Diagnosis Error

II. Malignant Lymphoma Diagnosis Error

We were invited to consult at Gansu Provincial People’s Hospital. The patient was Liu, a 60-year-old man who had experienced chest pain and shortness of breath for three months, diagnosed with coronary heart disease. He had been hospitalized in the high-level ward of the provincial hospital for over a month, but his treatment was ineffective. Recently, his condition worsened, prompting us to request a consultation. Two to three months earlier, the patient began experiencing intermittent chest and epigastric pain accompanied by palpitations and shortness of breath. His electrocardiogram showed S-T segment changes, and he was treated for coronary heart disease. Recently, the pain had shifted to the gastric region; gastroscopy confirmed gastritis with atrophic gastritis. In addition to medications for coronary heart disease, he also took Lozol and Guifuan. Despite taking these medications, the chest and epigastric pain did not subside, and he continued to experience significant weight gain. We observed that the patient was thin and weak, with obvious tenderness in the upper abdomen, and a mass could be felt in the upper part of the stomach, with an unclear border. We recommended performing a gastroscopic biopsy to analyze the condition, noting that the mass might be malignant. In addition to coronary heart disease and atrophic gastritis, the patient may also have malignant lymphoma. Three days later, we returned for another consultation. Gastroscopy revealed a mass in the gastric body, pushed inward from the outside, and a biopsy confirmed malignant lymphoma (non-Hodgkin’s). We recommended chemotherapy using the COPP regimen, based on supportive care. Two months later, the attending physician at the hospital called to report that, after the aforementioned treatment, the patient’s chest and epigastric pain had disappeared, and the mass in the upper abdomen had also vanished. The patient’s mental state improved, his physical strength gradually recovered, and he was discharged to continue recuperation at home. The main symptom of this patient was chest and epigastric pain; because of electrocardiographic changes, he was mistakenly diagnosed with coronary heart disease; due to gastrointestinal changes, he was mistakenly diagnosed with atrophic gastritis. While coronary heart disease and atrophic gastritis are indeed present, the primary cause of chest and epigastric pain was malignant lymphoma infiltrating the gastric wall. It was precisely because of this that the patient had been hospitalized in the high-level ward for over a month, and his previous treatment had been ineffective.