Burkitt’s Lymphoma of the Stomach: A Case Report and Review of the Literature

Case Report

J Blood Disord. 2014;1(3): 4.

Burkitt’s Lymphoma of the Stomach: A Case Report and Review of the Literature

Neil Watson1,2, Vincenzo Cassibba1, Marco Casini1, Andrea Mega3, Martina Tauber4, Andrea Iori3, Raimondo Di Bella1 and Andrea Piccin1*

1Haematology Department, San Maurizio Regional Hospital, Italy

2University of Edinburgh, United Kingdom

3Gastroenterology Department, San Maurizio Regional Hospital, Italy

4Pathology Department, San Maurizio Regional Hospital, Italy

*Corresponding author: Andrea Piccin, Haematology Department and Bone Marrow Transplant Unit, San Maurizio Regional Hospital, Bolzano/Bozen, South Tyrol, Italy.

Received: September 18, 2014; Accepted: October 02, 2014; Published: November 07, 2014

Abstract

Sporadic Burkitt’s Lymphoma (BL) is a subtype of Non-Hodgkins Lymphoma (NHL). In contrast to other types of NHL, sporadic Burkitt’s lymphoma usually affects the ileocaecal area of small bowel. We report a case of sporadic BL affecting the stomach, which represents an under-reported manifestation of the disease. This is followed by a review of the literature on gastric Burkitt’s lymphoma.

Keywords: Burkitt lymphoma; Gastric présentation; Helycobacter pylori; Gastric resection

Introduction

Sporadic Burkitt Lymphoma (BL) is an aggressive subtype of B cell Non-Hodgkin Lymphoma (NHL) which is rare in adults. The disease typically manifests in the Gastrointestinal (GI) tract, usually at the ileocaecal area [1]. The pathogenetic hallmark of BL is rearrangement of the c-MYC oncogene, an important regulator of cell proliferation and apoptosis. While the stomach is the commonest extra nodal site of presentation for other types of NHL [2], gastric presentation of sporadic BL is rare. The true prevalence of gastric BL is unclear due to a paucity of reports, and it may be under-recognized by clinicians. Correct diagnosis of BL is crucial, as prompt management is imperative and outcomes differ from other types of NHL. We report a case of sporadic BL presenting with gastric erosion in an adult male and we compare our findings with previous reports.

Case Description

Case #1

A 23 year old man presented in January 2013 to the Accident and Emergency Department of San Maurizio Regional Hospital of Bolzano, Italy, complaining of a three months history of abdominal pains, and increasing asthenia, fever, night sweats and weight loss of 10Kg. Examination revealed diffuse pallor, tachycardia, and marked epigastria pain. There was no lymphadenopathy, hepatosplenomegaly or palpable masses. Baseline full blood count revealed hemoglobin 7.5 g/dl (12-18), white cell count 8.7 x109/L (4.8-10.8), neutrophils 60.2% (40-74), lymphocytes 24.7% (19-48%), monocytes 11.7 (0.2-1), eosinophils 2.5 % (0-0.7), basophils 0.9% (0-0.2%), platelet count 496 x109/L (130-400). Other results included Erythrocyte Sedimentation Rate (ESR) 46mm (<25), prothrombin time 0.95 (<1.2), creatinine 0.58mg/dl (0.7-1.2), LDH 1121 IU (<225), protein 5.1g/dl (6.6-8.3), triglycerides 204 mg/dl (30-150). Serological studies shown: CMV IgG+ IgM-, HSV1/HSV2 IgG+ IgM-, VZV IgG+ IgM-, HAV IgG+ IgM-, HCV Ab-, HIV Ag/Ab-, HBs-Ag -ve, HBsAb+, HbcAb+, HbeAg-, HbeAb+, HBV DNA not elevated, EBV Ig G– IgM-.

An Oesophago-Gastroduodenoscopy (OGD) demonstrated a large gastric ulceration involving two-thirds of the body of the stomach and duodenum (Figure 1 OGD).