P2059 - Rapidly Progressive Diffuse Large B-cell Lymphoma

Matthew Everwine, DO¹, Sindhu Maramupdi, DO², Maulik Shah, DO³, Wei Hong, MD⁴, Brian Blair, DO^5
1Rowan SOM/Jefferson Health NJ, Franklinville, NJ; ²Rowan University School of Osteopathic Medicine, Stratford, NJ; ³Rowan University School of Osteopathic Medicine, Cherry Hill, NJ; ⁴Thomas Jefferson University, Cherry Hill, NJ; ⁵Jefferson Health, Cherry Hill, NJ

Introduction: Diffuse large B-cell lymphoma (DLBCL) is a type of non-Hodgkin’s lymphoma. DLBCL can arise de novo from mature B cells due to genetic mutations or as a result of transformation from low grade B cell lymphomas such as B cell CLL, follicular lymphoma, or MALT lymphoma. Primary gastric lymphomas including DLBCL are rare and account for 2-8% of gastric malignancies. The case that follows is a patient who was diagnosed with a gastric mass that was determined to be DLBCL.

Case Description/Methods: A 72 year old female presented to the hospital for decreased appetite and dyspepsia for one week in duration. She denied nausea, vomiting, constipation, change in stool habits, or weight loss. She was found to have a normal liver function panel, lipase 167, hemoglobin 10.8, MCV 84.2, Iron 20, TIBC 321, and ferritin of 21. A CT was obtained and revealed a large gastric mass extending into the retroperitoneum, anterior omentum and pancreatic body measuring 9x10cm. An upper endoscopy was subsequently performed which demonstrated a 10cm ulcerated and necrotic gastric body mass without obstruction. Biopsies were obtained showing large atypical/neoplastic lymphocytes infiltrating gastric lamina propria and submucosa. Immunohistochemical stain was positive for CD45, CD20, CD79a, PAX5, MUM1, BCL2, BCL6 (strong), CD30, and c-Myc. The patient was then diagnosed with DLBCL. The patient was subsequently discharged with close follow up with oncology.

Discussion: Gastric lymphomas account for only 0.9% of gastrointestinal tumors. Presenting symptoms may include dysphagia, nausea, vomiting, abdominal fullness, and indigestion. B symptoms such as fevers, weight loss, and night sweats can also be present. At time of diagnosis, up to 60% of patients will present with stage III/IV disease. Factors that correlate with a poor prognosis include age over 60 years, elevated serum LDH, clinical stage III/IV and greater than 1 extranodal area of disease. Treatment primarily includes chemotherapy with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) and the addition of rituximab in patients with CD20 positive tumors. Our patient presented with reported dysphagia for only one week. Interestingly, she had an unremarkable CT scan just 14 months prior. This finding supports the rapid growth tendencies associated with DLBCL. As a result, clinicians should consider rare gastric malignancies such as DLBCL in patients with new symptom onset even with a recent evaluation of the gastrointestinal tract.



Disclosures:


Matthew Everwine, DO¹, Sindhu Maramupdi, DO², Maulik Shah, DO³, Wei Hong, MD⁴, Brian Blair, DO⁵. P2059 - Rapidly Progressive Diffuse Large B-cell Lymphoma, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.