CASE REPORT
A 50-year-old man presented with epigastric pain and 2 days of hematochezia. Esophagogastroduodenoscopy showed polypoid and ulcerated nonbleeding masses up to 20 mm throughout the stomach to the third portion of the duodenum (Figure 1). Two nonbleeding cratered ulcers were found in the duodenal bulb (Figure 2). Colonoscopy showed many multilobulated, pedunculated, and ulcerated polyps throughout the rectum to the cecum ranging from 4 to 30 mm (Figure 3). Computed tomography revealed diffuse concentric small bowel wall thickening, multiple hepatic lesions, and lymphadenopathy (Figure 4). Histopathology and fluorescence in situ hybridization studies from gastric and colonic polyps were consistent with Burkitt lymphoma (BL). He was promptly treated with the Magrath regimen, with complete resolution 3 months after chemotherapy.
Figure 1.
Retroflexed view showing multiple polyps throughout the stomach.
Figure 2.
Forest class 3 ulcer in the duodenal bulb.
Figure 3.
Representative image of multiple multilobulated, pedunculated polyps in the colon ranging from 4 to 30 mm.
Figure 4.
Initial abdominal pelvic computed tomography showing diffuse colonic wall thickening.
BL is a subtype of non-Hodgkin lymphoma.1 Primary gastrointestinal non-Hodgkin lymphoma accounts for only 1%–4% of malignancies in the stomach, small intestine, and colon.2 Patients with abdominal BL often present with constipation, ascites, abdominal or back pain, nausea, vomiting, melena, and/or hematochezia.3 Using the BL International Prognostic Index, our patient had high-risk disease with a 3-year overall survival of 59% and a 3-year progression-free survival of 53%. BL can be considered in patients presenting with hematochezia with a good prognosis if diagnosed and treated promptly.
DISCLOSURES
Author contributions: All authors were involved in preparing this article, editing for accuracy, and providing final approval. RH Shah is the article guarantor.
Financial disclosure: None to report.
Previous presentation: This case was presented at the American College of Gastroenterology 2021 Annual Scientific Meeting Abstracts; October 2021; Las Vegas, Nevada.
Informed consent was obtained for this case report.
Contributor Information
Charlotte Chaiklin, Email: charlotte.chaiklin@jhsmiami.org.
Shyam Vedantam, Email: shyam.vedantam@jhsmiami.org.
Oscar Hernandez, Email: ohernan2@health.fau.edu.
REFERENCES
- 1.Molyneux EM, Rochford R, Griffin B, et al. Burkitt's lymphoma. Lancet. 2012;379(9822):1234–44. [DOI] [PubMed] [Google Scholar]
- 2.Loehr WJ, Mujahed Z, Zahn FD, Gray GF, Thorbjarnarson B. Primary lymphoma of the gastrointestinal tract: A review of 100 cases. Ann Surg. 1969;170(2):232–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Ferry JA. Burkitt's lymphoma: Clinicopathologic features and differential diagnosis. Oncologist. 2006;11(4):375–83. [DOI] [PubMed] [Google Scholar]