Midwestern University, Mountain Vista Medical Center Mesa, AZ, United States
Preeyanka Sundar, MD, MPH1, Suma Harsha Kosuru, MBBS2, Matthew Hillam, DO1, Sara Ancello, DO3 1Midwestern University, Mountain Vista Medical Center, Mesa, AZ; 2Mountain Vista Medical Center, Aldie, VA; 3Central Arizona Medical Associates, Mesa, AZ
Introduction: Gastrointestinal (GI) lymphoma constitutes 10-15% of Non-Hodgkin lymphomas, primary gastric lymphoma is rare, accounting for 2-8% of gastric cancer. We present a case of severe necrotic ulcers due to gastric lymphoma leading to perforation.
Case Description/Methods: A 66-year-old female presented with severe anemia, hyperglycemia in DKA, encephalopathy, and melena. Labs revealed leukocytosis 35.8K/mm3, hemoglobin 5.4, and lactic acid 7.4. Abdomen CT revealed 2.9cm gastric ulcer in lesser curvature, fused with distal body and tail of pancreas with stomach. Endoscopy revealed ischemic ulceration with nodularity, blackened mucosa, non-obstructing, clean-based gastric ulcers in the entire stomach. She was transfer to tertiary center for surgical evaluation and deemed stable for discharge then represented in 3 days with worsening abdominal pain, repeat CT showed free intraperitoneal air, two small foci of air in the diffusely thickened gastric wall. Emergency exploratory laparotomy with total gastrectomy, pancreatic necrosectomy, splenectomy, and partial colectomy was performed. Surgical pathology revealed diffuse high-grade large B-cell lymphoma.
Discussion: Perforation is a potential complication found in 9% of patients with GI lymphoma. A mortality rate of 60% was delineated in patients with perforated GI lymphoma, and 30% were directly due to the perforation or subsequent complications. Given the high mortality rate, early diagnosis, and treatment is crucial in patients with non-Hodgkin's lymphoma.
Figure: CT Abdomen: A, B revealed 2.9cm gastric ulcer in lesser curvature, fused distal body and tail of pancreas with stomach. Endoscopy: C, normal esophagus. D-H, ischemic ulceration with nodularity, blackened mucosa, non-obstructing, clean-based gastric ulcers in the entire stomach. I, normal duodenum. J Gastric lymphoma pathology, Lymphoma cells diffusely infiltrate between the gastric glands. Separation of gastric cells with architectural disruption. Round, oval, and irregular nuclei are present with scant cytoplasm. K. Concomitant component of low-grade marginal zone lymphoma (seen in 1/3 of cases). These cells arise from large cell transformation.
Preeyanka Sundar indicated no relevant financial relationships.
Suma Harsha Kosuru indicated no relevant financial relationships.
Matthew Hillam indicated no relevant financial relationships.
Sara Ancello indicated no relevant financial relationships.
Preeyanka Sundar, MD, MPH1, Suma Harsha Kosuru, MBBS2, Matthew Hillam, DO1, Sara Ancello, DO3. P1043 - Pop Goes the Weasel! An Unfortunate Presentation of Primary Gastric Lymphoma, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.