P4231 - Burkitt Lymphoma Presenting as a Gastric Cardia Polyp - A Rare Case Report

Deepan Panneerselvam, MD, Jeffrey Murray, MD, FACG
University of South Dakota Sanford School of Medicine, Sioux Falls, SD

Introduction: Current data demonstrate the malignant potential for gastric polyps as < 10% for sporadic fundic gastric polyps, up to 20% for hyperplastic polyps and up to 59% in adenomatous polyps with appropriate management and surveillance guidelines (1). However, guidelines based on other morphology and location of gastric polyps are lacking. Here we present a rare case of a 4mm umbilicated gastric cardia polyp that was diagnosed as Burkitt lymphoma.

Case Description/Methods: Our patient is a 73-year-old Caucasian male who presented with multiple episodes of hematochezia leading to acute blood loss anemia and a hemoglobin drop of 4 grams from baseline. On admission he was stabilized and the initial upper endoscopy revealed multiple non-obstructing oozing duodenal ulcers with adherent clot which were managed with injection, clipping and hemospray. However, he continued to have maroon-colored stools and persistent low hemoglobin. Repeat upper endoscopy was performed which revealed a 4mm sessile polyp that was umbilicated and two other 2mm sessile polyps all located in the gastric cardia. The 4mm polyp was biopsied with cold forceps and the pathology report came back positive for high grade B-cell lymphoma of the germinal center origin positive for CD20, PAX-5, CD10 and negative for CD3, CD5, BCL-2. The final pathology report was diagnostic of Burkitt lymphoma. Further PET CT workup revealed a Stage IV Burkitt lymphoma with involvement of lymph nodes of multiple organs. He was started on EPOCH-R chemotherapy regimen. After first two cycles, repeat EGD showed normal gastric mucosa. He tolerated a total of 6 cycles of EPOCH-R chemotherapy and 3 cycles of intermediate dose of methotrexate for CNS prophylaxis. His follow-up upper endoscopy after 3 years revealed normal gastric mucosa.

Discussion: Current ASGE guidelines recommend polypectomy of fundic gland polyps 1cm or larger, hyperplastic polyps 0.5 cm or larger and adenomatous polyps of any size when possible (1). Biopsy of this patient’s umbilicate appearing gastric polyp demonstrated a high grade B-cell lymphoma like Burkitt lymphoma. Polypectomy was not performed because of the umbilicate appearance. Further prospective studies are needed to evaluate the malignant potential of such umbilicated gastric polyps.

References:

1. ASGE Standards of Practice Committee; Evans JA et al. The role of endoscopy in the management of premalignant and malignant conditions of the stomach. Gastrointest Endosc. 2015 Jul;82(1):1-8. PMID: 25935705.



Disclosures:


Deepan Panneerselvam, MD, Jeffrey Murray, MD, FACG. P4231 - Burkitt Lymphoma Presenting as a Gastric Cardia Polyp - A Rare Case Report, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.