P3520 - Primary Burkitt Lymphoma of the GI Tract as a Rare Cause of Acute Upper GI Bleeding

Rasheed Musa, MD¹, Parth A. Goenka, MPH¹, Katrina Taylor, DO¹, Dhara Chaudhari, MD^2
1East Tennessee State University, Johnson City, TN; ²ETSU, Johnson City, TN

Introduction: Non-Hodgkin lymphoma is made from the B-cell lineage and includes Burkitt lymphoma. Burkitt lymphoma is associated with EBV and HIV. Although it is common for other B-cell lymphomas to develop in the stomach, it is less common for Burkitt lymphoma tumors to manifest there. Additionally, primary and/or secondary involvement of the duodenum, pancreas, and intestines is very rare in Burkitt lymphoma.

Case Description/Methods: 52-year-old male with a medical history significant for heart failure and multiple comorbidities presented with melena and abnormal weight loss. The patient had history of two months of chronic jaw abscess and osteomyelitis who was being managed by infectious disease and maxillofacial surgery. Patient presented with melena, fatigue, abdominal distension as well as unintentional weight loss of 35-40 lbs.

Laboratory investigation showed hemoglobin of 10 g/dl (baseline around 14 g/dl), normal MCV, elevated white cell count at 23.0 K/ul, and normal platelet count. His blood chemistry was remarkable for elevated BUN and elevated LDH >1500 units/L.

CT scan of the abdomen showed a thickening of the gastric wall, some irregularity noted in the lateral aspect of the stomach, and mild thickening at the level of the first and second portions of the duodenum.

The patient was resuscitated, transfused, and stabilized. EGD was performed and showed evidence of two large 4cm deep ulcers (clean based) identified at the lesser curvature of the stomach. Ulcer edge biopsies were taken per protocol.

Gastric ulcer biopsy pathology showed high-grade B-cell lymphoma consistent with Burkitt’s lymphoma.

Later, the patient’s jaw abscess and lesion were biopsied and also showed evidence of Burkitt’s lymphoma.

The patient’s hospital course was complicated by cardiac arrest secondary to tumor lysis syndrome.

Discussion: The primary involvement of BL or a small non-cleaved cell lymphoma in the GI tract is rare. Despite gastric lymphomas being more common than intestinal lymphomas, primary gastric involvement is extremely rare in BL. For non-endemic Burkitt’s lymphoma, the gastrointestinal tract is the most common site, followed by the retroperitoneal, kidney, ovary, and testes respectively.

Conclusion:

Gastric ulcers namely peptic ulcer disease is one of the most common causes of upper GI bleeding, however, the presence of atypical features during endoscopy such as ulcer size and depth should raise the suspicion of neoplastic process and biopsies should be performed per protocol.



Disclosures:


Rasheed Musa, MD¹, Parth A. Goenka, MPH¹, Katrina Taylor, DO¹, Dhara Chaudhari, MD². P3520 - Primary Burkitt Lymphoma of the GI Tract as a Rare Cause of Acute Upper GI Bleeding, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.