P1570 - Bumpy Stomach: High-Grade Stage IV Diffuse Large B-cell Lymphoma Presenting as Numerous Ulcerated Bleeding Gastric Nodules

Nabil El Hage Chehade, MD¹, Abdulfatah Issak, MD², Zijian Wang, MD³, Bolin Niu, MD^3
1Esophageal and Swallowing Center, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH; ²Case Western Reserve University, Cleveland, OH; ³MetroHealth Medical Center, Cleveland, OH

Introduction: In non-Hodgkin’s lymphoma, the two most common lesions of gastric involvement are extranodal marginal B cell lymphoma of mucosa associated with lymphoid tissue (MALT) type and primary or secondary diffuse large B-cell lymphoma (DLBCL). In the following case report, we present the case of an infiltrative high-grade DLBCL presenting as a gastrointestinal bleeding.

Case Description/Methods: A 67-year-old male patient presented for evaluation for a rapidly worsening anemia in the setting of melena. Computed tomography angiography (CTA) of the abdomen showed an active extravasation noted in the stomach along the greater curvature and the antrum with an adjacent intraluminal hematoma confined within the lumen. Additional findings included splenomegaly and prominent gastrohepatic lymphadenopathy. The patient then underwent an esophagogastroduodenoscopy (EGD) which showed numerous nodules with ulcerated central umbilication spread throughout the stomach, suspicious of an infiltrative process. Histopathology was consistent with DLBCL with positive c-MYC and BCL2 gene rearrangements. The patient was diagnosed with stage IV DLBCL with gastric infiltration from hematogenous spread and was initiated on aggressive chemotherapy.

Discussion: Distinguishing a primary from a secondary gastric lymphoma is challenging. Few studies have investigated various features and findings suggest that an ulceroinfiltrative morphology on endoscopy is a common feature of both, primary and infiltrative DLBCL. Generally, fundus or regional lymph node involvement is strongly associated with secondary gastric lymphoma. This case highlights the role endoscopy in aiding the diagnosis of infiltrative hematologic malignancies in the gastrointestinal tract.


Figure: (A) Hematoxylin and eosin stain (40x) showing a high-power view of high-grade DLBCL; (B and C) EGD findings of an infiltrative process within the stomach with multiple raised 10-15 mm ulcerated nodules characterized by central umbilication.


Disclosures:
Nabil El Hage Chehade indicated no relevant financial relationships.
Abdulfatah Issak indicated no relevant financial relationships.
Zijian Wang indicated no relevant financial relationships.
Bolin Niu indicated no relevant financial relationships.


Nabil El Hage Chehade, MD¹, Abdulfatah Issak, MD², Zijian Wang, MD³, Bolin Niu, MD³. P1570 - Bumpy Stomach: High-Grade Stage IV Diffuse Large B-cell Lymphoma Presenting as Numerous Ulcerated Bleeding Gastric Nodules, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.