University of Miami, Jackson Memorial Hospital Pembroke Pines, FL, United States
Rahil H. Shah, MD, Charlotte Chaiklin, MD University of Miami, Jackson Memorial Hospital, Miami, FL
Introduction: Burkitt Lymphoma (BL) is a subtype of Non-Hodgkin’s lymphoma (NHL) characterized by translocation and deregulation of the MYC gene on chromosome 8. We report a case of sporadic BL with diffuse gastrointestinal (GI) involvement presenting with hematochezia.
Case Description/Methods: A 50-year-old Filipino gentleman presented with moderate epigastric pain with a two-day history of bloody diarrhea. He had no past medical or surgical history. Patient was hemodynamically stable with mild epigastric tenderness to palpation and bright red blood on rectal exam. Initial labs were notable for a hemoglobin 7.1 gm/dL, and mildly elevated alkaline phosphatase. Abdominal ultrasound showed hepatomegaly at 19.1 cm and a hepatic lesion measuring 4.0 X 5.8 X 6.7 cm. Repeat hemoglobin twelve hours later was 6.0 gm/dL and he was taken for upper endoscopy (EGD) and colonoscopy.
EGD showed polypoid and non-bleeding ulcerated masses up to 20 mm diffusely throughout the stomach to the third portion of the duodenum with two Forrest Class III ulcers in the duodenal bulb. Colonoscopy was remarkable for multi-lobulated, pedunculated, and ulcerated polyps throughout the rectum to the cecum ranging from 4 to 30 mm. Computer tomography scans revealed diffuse concentric small bowel wall thickening, multiple hepatic lesions, and retroperitoneal and mesenteric lymphadenopathy. Pathology demonstrated BL with t(8;14) chromosomal translocation and MYC rearrangement. Treatment was initiated with Magrath regimen chemotherapy.
Discussion: Our patient was found to have a rare form of BL diffusely involving the GI tract from stomach to rectum. While the GI tract is a common site of secondary involvement of NHL, primary GI NHL is rare accounting for only 1 to 4% of malignancies of the stomach, small intestine, or colon. BL makes up less than 1% of adult NHL in the United States.
Our patient likely had the sporadic variant and is unique in his age of presentation (50 vs 20s-30s), country of origin (Philippines vs US/Europe) and vast involvement of the GI system. Abdominal involvement in patients with the sporadic form is usually limited to stomach and distal ileum due to their high lymphoid tissue concentration. This case had involvement from stomach to rectum and liver. There are no prior reports of a patient presenting with all five anatomical locations involved. BL is an important diagnosis to consider in patients presenting with hematochezia, abdominal pain, or other gastrointestinal symptoms.
Figure: Computer tomography scan of abdomen with PO contrast showing diffuse small and large intestinal wall thickening.
Disclosures: Rahil Shah indicated no relevant financial relationships. Charlotte Chaiklin indicated no relevant financial relationships.
Rahil H. Shah, MD, Charlotte Chaiklin, MD. P2306 - Burkitt Lymphoma of the Stomach, Colon, and Rectum Presenting as Hematochezia, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.