A Rare Case of High-Grade B-cell Lymphoma Involving the Colon and Small Bowel 2475
Gastrointestinal (GI) tract is the most common site of extranodal lymphoma. It could manifest as primary or secondary gastrointestinal lymphoma, the latter is more common. Among all the lymphomas in the GI tract, non-Hodgkin type (NHL) is more common and diffuse large B-cell being the majority in pa...
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| Published in: | The American journal of gastroenterology Vol. 113; no. Supplement; p. S1374 |
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| Main Authors: | , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
New York
Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
01-10-2018
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Gastrointestinal (GI) tract is the most common site of extranodal lymphoma. It could manifest as primary or secondary gastrointestinal lymphoma, the latter is more common. Among all the lymphomas in the GI tract, non-Hodgkin type (NHL) is more common and diffuse large B-cell being the majority in pathologic type. From literature review, overall GI lymphoma accounts for 5-20% and primary origin is rare with only 1-4%. Within the GI tract, the stomach, then followed by small bowel and ileocecal region are the most common sites of involvement. In this report, we present a case of a 52-year-old incarcerated male with a history of recently diagnosed HIV presented due to severe anemia. His hemoglobin was 7g/dl with hemoccult positive and iron saturation of 4%. Physical exam showed a cachectic African American male with protuberant abdomen with mild diffuse tenderness. Imaging was concerning for soft tissue lesions throughout the mesentery, an ill-defined air-fluid collection, small bowel and large bowel wall thickening and moderate ascites. Patient had upper endoscopy and colonoscopy with relevant findings of 2 clean based gastric and colonic ulcers. During the hospital course, patient also had excisional left inguinal lymph node biopsy. Although lymph node biopsy did not reveal malignancy, the colonic ulcers revealed diffuse large B-cell lymphoma (DLBCL), germinal center phenotype. Patient also underwent bone marrow biopsy which did not reveal lymphoma. Subsequently patient had PET scan that did not show bone marrow involvement. Within 2 weeks of initial presentation patient received first cycle of R-CHOP. One week later, he presented with acute abdomen and found to have pneumoperitoneum. In the meantime FISH analysis from pathology returned positive for T(8,14) or MYC/IGH fusion, associated with Burkitt lymphoma (BL). Patient had exploratory laparotomy with en-bloc resection of small bowel, mesentery and omentum due to necrotic tumor invasion. A day after surgery patient passed away. This high grade B-cell lymphoma, known as unclassifiable with features intermediate of DLBCL and BL has poor prognosis. Not only this case is unique in the sense of colonic involvement with NHL, but this adds a rare type of lymphoma to the literature with gastrointestinal involvement. |
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| ISSN: | 0002-9270 1572-0241 |
| DOI: | 10.14309/00000434-201810001-02474 |