Michael Andreone, MD1, Mohammad Bilal, MD2, Ioannis Pothoulakis, MD1 1University of Minnesota, Minneapolis, MN; 2University of Minnesota and Minneapolis Veterans Affairs Health Care System, Minneapolis, MN
Introduction: Non-Hodgkin lymphoma (NHL) represents approximately 2.7% of cancer cases worldwide and can frequently involve extranodal primary sites, including the gastrointestinal (GI) tract. The most common locations in the GI tract includes the stomach and ileum. Here we report a case of diffuse large B-cell lymphoma (DLBCL) in the jejunum.
Case Description/Methods: An 83-year-old male presented to his primary care provider with chronic constipation, loss of appetite, nausea, vomiting and weight loss. Computed tomography scan was performed and initially showed an enhancing mass in the upper pole of the left kidney concerning for malignancy. In addition, a heterogeneous, mass-like lesion along the posterior wall of a loop of the jejunum, with possible fistulous communication and new cephalad extension to the lower pole of left kidney, suspicious for either metastatic disease or additional primary tumor. Therefore, decision was made to perform single balloon enteroscopy. The enteroscope was advanced to the mid-jejunum where abnormal mucosa with ulceration and erythema was seen. Biopsies were obtained and immunohistochemical staining revealed B-cells expressing CD10, CD20, CD43/45, BCL-2, and BCL-6, confirming diagnosis of diffuse large B-cell lymphoma. After extensive discussion with the patient and his family about prognosis and treatment options, the patient ultimately opted to pursue hospice.
Discussion: Our report highlights that DLBCL in the jejunum is rare and can be easily missed as it can presents with nonspecific symptoms. When suspected, its diagnosis can be challenging due to the complex endoscopic approach required to obtain a tissue sample. Further studies are required to guide the management of these cases.
Figure: Figure 1) A: Endoscopic image of erythematous mucosa visualized in the mid-jejunum. B: Endoscopic image demonstrating ulceration and friable nature of mucosa visualized in the the mid-jejunum. C: Immunohistochemical stain of sample taken from the ulcerated area showing neoplastic cells positive for CD20. D: Immunohistochemical stain of aforementioned sample showing neoplastic cells positive for CD10. E: Immunohistochemical stain of aforementioned sample showing neoplastic cells positive for BCL-6
Michael Andreone indicated no relevant financial relationships.
Mohammad Bilal: Boston Scientific – Consultant.
Ioannis Pothoulakis indicated no relevant financial relationships.
Michael Andreone, MD1, Mohammad Bilal, MD2, Ioannis Pothoulakis, MD1. P2690 - A Case of Primary Diffuse Large B-Cell Lymphoma in the Jejunum, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.