Mario Tavakoli, DO, Alexander Pan, MD University of Illinois at Chicago, Chicago, IL
Introduction: Sarcoidosis-lymphoma syndrome is a rare condition that elucidates the association between sarcoidosis and the development of lymphoma. It is believed that the chronic active inflammation from sarcoidosis increases the risk of malignant transformation of lymphoid cells. There are only 4 documented cases of MALT lymphoma in patients with sarcoidosis, and we present the first reported case of a patient with H. pylori negative gastric MALT lymphoma preceding the diagnosis of gastric sarcoidosis.
Case Description/Methods: A 51-year-old African American man presented to the GI clinic for evaluation of early satiety and unintentional weight loss. The patient endorsed a cough with episodes of post-tussive emesis and shortness of breath. His past medical history included obstructive sleep apnea, hyperlipidemia, meningitis and diet-controlled IBS-D. Patient’s lab results were largely unremarkable, aside from an elevated Alk Phos (180) and ACE level (83). A CT revealed hilar lymphadenopathy, and biopsies from an EBUS-TBNA revealed a granulomatous lesion. The patient had an EGD which showed esophagitis and a single 30-35 mm flat lesion with no stigmata of bleeding in the greater curvature of the gastric body. Biopsy results were negative for H. pylori, however revealed massive B-cell infiltration of the gastric mucosa, with staining being indicative of MALT Lymphoma. The patient was diagnosed with pulmonary sarcoidosis and started on a Prednisone taper with significant improvement in his cough and dyspnea. The patient was then referred to Radiation Oncology and received 20 sessions of radiation therapy. A repeat surveillance EGD was grossly normal with negative biopsies. Another EGD 9 months later was also normal with biopsies negative for lymphoma, and the plan was to repeat an EGD in 6 months. The patient, however, was lost to follow up and returned to the GI clinic 2 years later complaining of epigastric pain and diarrhea after eating a red pepper. An EGD at that time showed esophagitis with scattered areas of mild localized erythema in the gastric antrum and body. Biopsy results were notable for non-caseating granulomas with chronic inflammatory cells, and a diagnosis of gastric sarcoidosis was made.
Discussion: Sarcoidosis-lymphoma syndrome has less than 79 reported cases, with only 4 reported cases involving MALT lymphoma. This is the first documented case of H. pylori negative MALT lymphoma developing before gastric sarcoidosis. This case highlights the importance of quality endoscopy.
Figure: Images of the final EGD depict scattered areas of mild localized erythema in the gastric antrum and body. Biopsies later revealed non-caseating granulomas with chronic inflammatory cells composed of few CD20 and CD79 positive B-cells and more CD3 and CD5 positive T-cells. A diagnosis of gastric sarcoidosis was made.
Disclosures:
Mario Tavakoli indicated no relevant financial relationships.
Alexander Pan indicated no relevant financial relationships.
Mario Tavakoli, DO, Alexander Pan, MD. P4246 - An Unusual Case of Sarcoidosis-Lymphoma Syndrome: Gastric MALT Lymphoma Preceding Development of Gastric Sarcoidosis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
