P0210 - Primary Gastrointestinal Lymphoma Presenting as a Large Bowel Obstruction in a Young Patient

Ian Naron, MD¹, Omer Chowdhury, DO¹, Bolarinwa F. Olusola, MD^2
1University of Texas Health Science Center at Tyler, Tyler, TX; ²University of Texas Health East Texas Physicians, Tyler, TX

Introduction: Primary Gastrointestinal Lymphoma is a rare manifestation of Burkitt’s lymphoma (BL). Gastrointestinal (GI) tract symptoms presenting as the primary complaint is rare. We present a case of a healthy 22 year old male presenting with chronic constipation found to have obstructing rectosigmoid mass confirmed to be BL.

Case Description/Methods: A healthy 22 year old male presented to an urgent care with complaints of worsening constipation for two months. A CT Abdomen and Pelvis showed rectosigmoid mass with multiple hepatic lesions concerning for stage IV rectal cancer with liver metastasis. Patient was transferred to the hospital for a higher level of care. Further history revealed the patient was suffering from pencil thin caliber of stool, fatigue, and 20 lb unintentional weight loss. Vital signs were stable. CBC showed a hemoglobin of 8 g/dL, a significant drop from prior lab results. GI was consulted and a colonoscopy revealed an obstructing exophytic/infiltrating ulcerated bleeding mass at the anal verge that extended 10 cm into the mid and proximal rectum (Figure 1). Biopsy obtained was non-diagnostic. General Surgery was consulted and the patient underwent laparoscopy with diverting colostomy and liver biopsy. The liver biopsy revealed high-grade B-cell lymphoma suggestive of Burkitt’s Lymphoma. The patient received HIV testing and was found to be HIV positive. The patient was discharged with a follow up appointment to oncology where the patient was started on DA-EPOCH-R regimen. The patient received Ommaya reservoir placement for intrathecal chemotherapy.

Discussion: Burkitt’s Lymphoma is an aggressive form of Non-Hodgkin’s lymphoma. There are three separate variants of BL: endemic, sporadic, and immunodeficiency. BL patients typically present with growing masses in the abdomen, head or neck region. Our patient had unintentional weight loss, but he did not have other B symptoms typical of BL such as fever and night sweats. Although GI involvement is a common finding in BL, primary gastrointestinal lymphoma is rare. Patients have localized GI symptoms, such as constipation. Our patient also had associated undiagnosed HIV infection. Therapy for BL is aggressive and multiple protocols exist. Since discharge, our patient completed 6 cycles of chemotherapy and is on HAART therapy. A follow up colonoscopy is scheduled.



Disclosures:


Ian Naron, MD¹, Omer Chowdhury, DO¹, Bolarinwa F. Olusola, MD². P0210 - Primary Gastrointestinal Lymphoma Presenting as a Large Bowel Obstruction in a Young Patient, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.