P4208 - B Cell Lymphoma Presenting as Linitis Plastica

John Ko, DO, Keaton Maguire, DO, Phillip Oberg, DO, Sara Alleyasin, DO, Vishvinder Sharma, MD
Valley Hospital Medical Center, Las Vegas, NV

Introduction: Linitis Plastica is classically described in the literature as a thickening of the gastric walls that gives the appearance of a “leather bottle” and is associated with gastric adenocarcinoma. However, there have not been many case reports that show that B cell Lymphoma can simulate the appearance of linitis plastica. We present an unusual case of such in a patient that presented to our medical center.



Case Description/Methods: 78 year old male initially presented to our hospital for concerns of altered mental status. Initial workup was remarkable for tachycardia at 131, Hemoglobin 9.1, Creatinine 1.31, Calcium 12.3, Lactic Acid 3.1. Physical exam was unremarkable. CT scan without contrast of the head demonstrated multiple lucent lesions in the spine concerning for a myelomatous process. GI was consulted after the patient developed acute episodes of melena and drop in hemoglobin from 9.1 to 6.7. CT abdomen and pelvis with IV contrast was performed and demonstrated a thickening of the gastric walls measuring 1.4 cm that was deemed concerning for linitis plastica as well as extensive epigastric and retroperitoneal adenopathy. Upon further questioning of the wife, it was revealed that the patient had received an EGD a couple of months prior at the VA after an incidental gastric thickening was found on imaging for workup of his generalized hip and buttock pain. The procedure led to the discovery of a large ulcerating gastric mass that was biopsied and returned positive for high grade B cell lymphoma. Patient underwent a repeat EGD at our facility where a 5cm excavated large gastric ulcer with irregular appearing mucosa and multiple blood clots was visualized in the entire lesser curvature of the stomach. There was also friable and erythematous mucosa throughout the stomach and multiple duodenal nodules noted in D1 and D2. Hemospray was deployed to the region of the ulcer prior to termination of the procedure. The patient had no more episodes of melena after completion of the EGD but sadly passed before further workup could be completed.

Discussion: Lymphoma presenting as linitis plastica is rarely seen. Treatment options include subtotal gastrectomy with gastrojejunostomy or total gastrectomy and esophagojejunostomy but only if they are within IE and IIE on the Ann Arbor classification. Ulceration is a feature frequently seen in linitis plastica lymphomas as shallow depressions, or deep and well demarcated. This case serves to highlight awareness to a unique manifestations of linitis plastica.





Disclosures:


John Ko, DO, Keaton Maguire, DO, Phillip Oberg, DO, Sara Alleyasin, DO, Vishvinder Sharma, MD. P4208 - B Cell Lymphoma Presenting as Linitis Plastica, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.