P5122 - A Rare Case of Dysphagia as a Herald Sign of Gastric Diffuse Large B Cell Lymphoma

Jason John, DO¹, Brian Blair, DO², Lucy Joo, DO², Andrew Dargan, MD³, Christopher Chhoun, DO², Neethi Dasu, DO^4
1Jefferson Health, Pennsauken, NJ; ²Jefferson Health, Cherry Hill, NJ; ³Thomas Jefferson University Hospital, Philadelphia, PA; ⁴Beth Israel Lahey Health, Burlington, MA

Introduction: Diffuse Large B-cell lymphoma (DLBCL) of the stomach is a rare and aggressive type of non-Hodgkin lymphoma originating from gastric lymphatic tissue. Patients with gastric DLBCL typically present with nonspecific gastrointestinal symptoms, which can include abdominal pain, nausea, vomiting, and weight loss. We report a case of diffuse large B-cell gastric Lymphoma who initially presented with dysphagia and recurrent regurgitation.

Case Description/Methods: An 83-year-old female presented with a two-month history of nausea, unintentional 15-pound weight loss, dysphagia and regurgitation of swallowed food or liquids following meals. The patient had no prior history of endoscopic examinatioons, denied tobacco use or family history of malignacy. Laboratory workup revealed macrocytic anemia with a hemoglobin level of 11.3 g/dL and MCV of 101.6 fL. A CT scan of the abdomen and pelvis with IV contrast showed mass-like thickening at the gastric fundus abutting the gastroesophageal junction (GEJ), measuring 2.0 cm in thickness. Following these findings, an EGD was performed, which demonstrated a large ulcerated and fungating mass involving the distal esophagus, GEJ, and proximal stomach, extending from 37 cm to 55 cm from the incisors, along with a moderate amount of liquid and food debris in the esophagus and stomach. Histopathology confirmed diffuse large B-cell lymphoma (DLBCL), germinal center type, with focal lymph node involvement. Immunohistochemical stains were performed and showed malignant lymphocytes which were positive for CD20, BCL6, CD10, weakly patchy positive for Bcl-2. Due to the size and distribution of the mass, the patient was not a candidate for endoscopic stenting or percutaneous endoscopic gastrostomy (PEG) placement. She underwent surgical jejunostomy placement and was referred to oncology for initiation of chemotherapy.

Discussion: Our patient presented with dysphagia and was found to have an 18 cm infiltrating DLBCL extending from the distal esophagus into the proximal stomach. Her primary issue of recurrent regurgitation of food and liquid after meals further pointed to a potential obstruction within the upper gastrointestinal tract. Primary Gastric lymphoma is a rare clinical entity, and timely diagnosis with upper endoscopy and appropriate management involving chemotherapy is essential to improve patient outcomes. This case highlights the challenges in diagnosing and managing gastric lymphoma, especially in elderly patients with complex and unique presentations.



Disclosures:


Jason John, DO¹, Brian Blair, DO², Lucy Joo, DO², Andrew Dargan, MD³, Christopher Chhoun, DO², Neethi Dasu, DO⁴. P5122 - A Rare Case of Dysphagia as a Herald Sign of Gastric Diffuse Large B Cell Lymphoma, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.