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• W2921884783 abstract "Diffuse large B cell lymphoma (DLBCL) is a common lymphoma accounting for 25% of all Non-Hodgkin lymphomas. Extra nodal disease occurs in around 40% of cases with the stomach being the most common site. Gastric DLBCL usually presents with symptoms of epigastric pain, nausea, vomiting and unexplained weight loss. Rarely is GI bleeding the primary complaint. Here we describe a patient whose symptoms were melena and hematemesis. An 88-year old man presented with an episode of hematemesis, several weeks of intermittent melanic stools, and nonspecific abdominal fullness. His past medical history was significant for malignant melanoma and basal cell carcinoma, myasthenia gravis, and stage III chronic kidney disease. He had a remote thirty pack year history of tobacco abuse. He was also a veteran of the armed services and had witnessed three above-ground nuclear test detonations. He was tachycardic and hypotensive. He had no palpable cervical, axillary, abdominal, or inguinal lymphadenopathy. He had no palpable abdominal masses. There was no hepatosplenomegaly. His hemoglobin was 7.4. An HIV screen was negative. An EGD revealed large ulcerating, fungating friable masses with heaped up margins in the stomach. They were located in the cardia, the greater curvature, and the lesser curvature (images 1 & 2). Biopsies were positive for CD20 and BCL6, consistent with diffuse large B-cell lymphoma. Random stomach biopsies demonstrated inactive mild chronic gastritis and no morphologic evidence for H. pylori. A PET/CT demonstrated extensive FDG-avid diffuse changes of lymphoma. The most extensive involvement of the lymphoma was within the right upper quadrant and proximal half of the stomach with a maximum dimension of 15.4 cm (image 3). Owing to high tumor burden and risk for TLS the patient was admitted for R-CHOP therapy. The most common etiologies of upper gastrointestinal bleeding are gastric/duodenal ulcers, esophagogastric varices with or without portal hypertensive gastropathy, and Dieulafoy's lesions. Hematologic malignancies are rare causes of hematemesis and when identified are mostly present in the duodenum. This case highlights DLBCL as a rare cause of GI bleeding. It is important for clinicians to consider DLBCL in the differential diagnosis when evaluating gastrointestinal bleeding in elderly patients with vague symptoms and no clearly identifiable culprit at the time of their presentation.2989_A Figure 1. Proximal view of gastric lesions visualized on EGD.2989_B Figure 2. Retroflexed view of gastric lesions visualized on EGD.2989_C Figure 3. PET/CT coronal view demonstrating large tumor burden." @default.
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• W2921884783 date "2018-10-01" @default.
• W2921884783 modified "2023-09-27" @default.
• W2921884783 title "An Uncommon Culprit for Hematemesis: Gastric Diffuse Large B-Cell Lymphoma" @default.
• W2921884783 doi "https://doi.org/10.14309/00000434-201810001-02988" @default.
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