University of Tennessee Health Science Center Memphis, TN, United States
Tony Cheng, MD1, Kyle R. Kreitman, DO1, Abdul Aleem, MD2, Jiten Kothadia, MD1 1University of Tennessee Health Science Center, Memphis, TN; 2Lehigh Valley Health Network, Allentown, PA
Introduction: Lymphomas are solid malignancies of the lymphoid system and are classified into Hodgkin's lymphoma or non-Hodgkin's lymphoma. GI lymphomas typically present secondary to widespread nodal disease. Primary GI lymphomas are rare and make up only 1-4% of GI malignancies. Here we present a case of a patient with acute upper GI bleed who was found to have a primary Burkitt’s Lymphoma (BL) involving the stomach.
Case Description/Methods: A 44-year-old woman with history of AIDS presented to the ED with fevers, chills, and melena. Her physical exam was unremarkable. Labs were significant for a Hb 6 g/dL, WBC 5.0 thou/mcL, platelet count 146 thou/mcL, and CD4 count 4 cells/uL. CT scan of the abdomen was unremarkable. An esophagogastroduodenoscopy showed extensive nodularity of the stomach wall with a 6 mm clean-based ulceration noted in the body of the stomach (Image A1). Biopsies were obtained from the gastric mucosa, revealing diffuse infiltration of the submucosal layer by atypical lymphoid cells with coarse nuclei, high mitotic activity, and apoptotic cells (Image A2). Histochemical evaluation revealed neoplastic cells positive for CD20 (Image A3), C10, BCL6, and C-MYC (Image A4). The fluorescence in situ hybridization analysis demonstrated IgH-MYC translocation, confirming the diagnosis of Primary Burkitt’s lymphoma. Highly active antiretroviral therapy and chemotherapy was initiated. Her clinical course was complicated by multiorgan system failure, and she transitioned to hospice care.
Discussion: Our case highlights a rare presentation of primary gastric BL presenting as an upper GI bleed. A high index of suspicion for lymphomas is required for immune compromised patients presenting with GI bleeding. As survival of HIV patients continues to improve with HAART, more primary gastric BL cases will likely be described in the literature.
1. Ghimire P, Wu G-Y, Zhu L. Primary gastrointestinal lymphoma. World journal of gastroenterology: WJG. 2011;17(6):697. 2. Blum KA, Lozanski G, Byrd JC. Adult Burkitt leukemia and lymphoma. Blood. 2004;104(10):3009-20.
Figure: A1) Endoscopic imaging showing 6mm gastric ulcer and nodularity of the gastric mucosa. A2) H&E staining showing diffuse infiltration of the submucosal layer by atypical lymphoid cells with coarse nuclei, high mitotic activity, and apoptotic cells. A3) Histochemical evaluation Positive for CD20. A4) Histochemical staining positive for C-MYC.
Tony Cheng indicated no relevant financial relationships.
Kyle Kreitman indicated no relevant financial relationships.
Abdul Aleem indicated no relevant financial relationships.
Jiten Kothadia indicated no relevant financial relationships.
Tony Cheng, MD1, Kyle R. Kreitman, DO1, Abdul Aleem, MD2, Jiten Kothadia, MD1. P1561 - The Devil Is in the Details: Uncommon Cause of Upper GI Bleed, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.