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• W2912428229 abstract "Introduction: Primary effusion lymphoma is one of the least common of the AIDS/HIV related lymphomas, accounting for only up to 4% of reported cases. This case reviews an atypical appearing gastric ulcer with surrounding nodularity on upper endoscopy performed for persistent epigastric abdominal discomfort with associated nausea/emesis. Case: This is a 51 year old male with pmhx of HIV on elvitegravir/cobicistat/emtricitabine/tenofovir, HTN, and obesity who presented for complaints of epigastric pain with associated nausea/emesis and unintentional weight loss of 5 lbs despite trial of PPI therapy. A cardiac workup was negative. Labs were noted for a normocytic anemia with Hg of 9.5 and MCV of 80.6. An EGD was revealing of a 3cm circumferential, cratered gastric ulcer on the lesser curvature of the proximal gastric body with multiple raised nodules in the cardia/distal gastric body. Multiple biopsies of the nodules and ulcer margins were taken and sent to University of Chicago for expert review. They were revealing of a lymphoma with plasmablastic features consistent with extracavitary primary effusion lymphoma, positive for HHV-8 and EBER negative. Further workup with an echo was noted for EF of >70% without valvulopathy and normal pericardium without effusion. A CT chest/abdomen/pelvis was negative for PE, pleural effusions. or any intra-abdominal pathology. The patient's clinical course was complicated by poor medical follow up. He presented one month later with obstructive symptoms and was found to have a small bowel obstruction, thought to be due progression of his lymphoma. He was transferred to a tertiary center for initiation of chemotherapy.Figure: Raised mucosal nodule with central depression (gastric body).Figure: 3cm circumferential, non-bleeding, cratered gastric ulcer with raised mucosal border (lesser curvature/proximal gastric body).Figure: 3cm circumferential, non-bleeding, cratered gastric ulcer with raised mucosal border (retroflexed view).Discussion: This case highlights the continued need to pursue aggressive biopsies in irregular appearing gastric ulcers with atypical endoscopic features. Primary effusion lymphoma is the least common of the acquired HIV-related lymphomas commonly seen in the setting of HHV-8 infection, accounting for only up to 4% of cases. Rarely, it can also present in patients who have undergone solid organ transplant or in chronic hepatitis C infection. It commonly originates in the pleura, pericardium, or peritoneum. GI tract involvement is less common but still reported. Treatment regimens include antiviral therapy in conjunction with EPOCH, CHOP, or other combination regimen; however, there is no current standard chemotherapy recommendation. Median survival rates are estimated around six months." @default.
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• W2912428229 date "2017-10-01" @default.
• W2912428229 modified "2023-09-27" @default.
• W2912428229 title "A Rare Endoscopic Finding on Routine Upper Endoscopy" @default.
• W2912428229 doi "https://doi.org/10.14309/00000434-201710001-02604" @default.
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