P1356 - A Rare Case of Primary Sporadic Gastric Burkitt Lymphoma

Mudassar Sandozi, DO¹, Basil Muhanna, ², Ahmet Sakiri, MD¹, Thayer Hamoudah, MD¹, Naser Khan, MD¹, Altaf Dawood, MD, MBBS^1
1MercyHealth, Rockford, IL; ²University of Illinois College of Medicine, Rockford, IL

Introduction: Burkitt lymphoma (BL) is an aggressive form of non-Hodgkin B-cell lymphoma associated with Epstein Barr virus, human immunodeficiency virus, and chromosomal translocations. Sporadic BL is a rare condition with an incidence of 2.5 per 1 million adults globally. Although secondary involvement of the GI tract is common in lymphomas, primary gastric lymphomas are rare. We present a case of gastric Burkitt’s lymphoma in a patient presenting with symptoms of severe iron deficiency anemia.

Case Description/Methods: A 65-year-old female with history of atrial fibrillation (on apixaban) presented to the ED with a 4 month history of dyspnea, melena, and 60 lbs of weight loss. On presentation, patient was hypotensive and in Afib with a rapid ventricular response. Labs showed severe iron deficiency anemia (hemoglobin 3.1 g/dL, ferritin 12.5 ng/mL, iron 10 mcg/dL, and TIBC 324 mcg/dL). Colonoscopy was unremarkable. EGD revealed a large, infiltrative, ulcerated mass in the gastric body, incisura, gastric antrum, and the pre-pyloric region of the stomach. Biopsied tissue stained positive for CD45, CD20, PAX5, CD43, c-Myc, and BCL6, consistent with B-cell lymphomas. After blood transfusions and stabilization, she was discharged with instructions to follow up with oncology for cancer staging and treatment options. The patient was started on dose-adjusted etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone, and rituximab (DA-EPOCH-R) chemotherapy. After her first treatment cycle, she developed neutropenic sepsis secondary to COVID, further complicated by superimposed bacterial pneumonia, which ultimately took her life.

Discussion: BL occurs in three forms: endemic, immunodeficiency-related, and sporadic. Endemic BL is most commonly associated with malaria and occurs in children in Sub-Saharan Africa. Immunodeficiency-related BL is primarily seen in patients with HIV and those undergoing organ transplant. Sporadic BL occurs globally and presents most often as an abdominal lymphoma in adults 30-50 years old. All types of BL can involve the GI tract. Primary gastric BL is a rare and diagnostically challenging entity, with roughly 50 cases reported world-wide. BL has a growth fraction near 100% and a doubling time of 24 hours. Patients can present with weight loss, progressive anemia, or fatal hemorrhage. It should be a considered differential when gastric wall thickening is present on endoscopic evaluation, and once confirmed with biopsy, treatment must promptly ensue.



Disclosures:


Mudassar Sandozi, DO¹, Basil Muhanna, ², Ahmet Sakiri, MD¹, Thayer Hamoudah, MD¹, Naser Khan, MD¹, Altaf Dawood, MD, MBBS¹. P1356 - A Rare Case of Primary Sporadic Gastric Burkitt Lymphoma, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.