P3125 - A Rare Case of Primary Gastric Burkitt Lymphoma

Benjamin Souferi, DO, MS¹, Maurice Marcuard, MD², Ali Alshati, ³, Kunchang Song, MD⁴, John Sotiriadis, MD, PhD, FACG^5
1Hackensack Meridian Palisades Medical Center, Roslyn Heights, NY; ²Hackensack University Medical Center Palisades, Hackensack, NJ; ³Hackensack University Medical Center, Roselle, NJ; ⁴Hackensack University Medical Center, Hackensack, NJ; ⁵HMH Palisades Medical Center, North Bergen, NJ

Introduction: Primary lymphomas of the gastrointestinal (GI) tract are exceedingly rare and represent 4-20% of all extranodal lymphomas. The stomach is the most common site of extranodal non-Hodgkin lymphoma. The predominant subtype of primary gastric lymphoma is diffuse large B-cell lymphoma. Low-grade marginal zone lymphoma of the MALT type and Burkitt lymphoma are the other subtypes of primary gastric lymphoma. Here we present a rare case of primary gastric Burkitt lymphoma.

Case Description/Methods: A 56-year-old male with a past medical history of hypertension and diabetes presented to the emergency department with a 3-day history of melanic stool and generalized abdominal pain. The physical exam was unremarkable. Computed Topography (CT) revealed a multifocal pneumonia with multiple hepatic lesions. Esophogastroduodenoscopy was performed and multiple ulcerated gastric nodules were seen and biopsied (Figures 1A and 1B). The positron emission tomography (PET)-CT demonstrated activity within the stomach. Magnetic resonance imaging (MRI) with contrast was consistent with lymphoma in both the thoracic and lumbar spine. The immunohistochemical evaluation revealed a monoclonal population of B cells. Fluoresce in situ hybridization analysis revealed IgH/C.MYC rearrangement (Figure 1C,D). The overall findings and molecular genetics were consistent with Burkitt lymphoma. He was also found to be positive for human immunodeficiency virus (HIV).

Discussion: Primary gastric Burkitt lymphoma is exceptionally rare in adults. Only 200 cases are reported in the literature. Burkitt lymphoma is an aggressive B-cell malignancy with a high proliferation rate. Genetic changes involving the c-myc oncogene is the hallmark of Burkitt lymphoma. Three variants of Burkitt lymphoma have been described: endemic, sporadic, and immunodeficiency. The immunodeficiency subtype of Burkitt lymphoma is frequently observed in the setting of HIV infection, as is in this case.



Adult patients with sporadic or immunodeficiency associated Burkitt lymphoma typically present with extranodal disease in the abdomen with non-specific symptoms including abdominal pain, nausea, vomiting, GI bleeding, and bowel obstruction. Although secondary GI involvement is relatively common in lymphoma, primary gastrointestinal lymphoma is extremely rare. Due to the very aggressive nature of Burkitt lymphoma, immediate intervention is usually required.


Figure: 1A,B multiple ulcerated gastric nodules. 1C Immunostaining of C-myc. 1D H&E Staining.


Disclosures:
Benjamin Souferi indicated no relevant financial relationships.
Maurice Marcuard indicated no relevant financial relationships.
Ali Alshati indicated no relevant financial relationships.
Kunchang Song indicated no relevant financial relationships.
John Sotiriadis indicated no relevant financial relationships.


Benjamin Souferi, DO, MS¹, Maurice Marcuard, MD², Ali Alshati, ³, Kunchang Song, MD⁴, John Sotiriadis, MD, PhD, FACG⁵. P3125 - A Rare Case of Primary Gastric Burkitt Lymphoma, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.