Mohamed A. Elkhouly, MD, MSc1, Bashar M. Attar, MD, PhD1, Ahmed A. Elkafrawy, MD2, Miguel Salazar, MD1, Ishaan Vohra, MD3, Hemant Mutneja, MD3, Oscar Rivas Chicas, MD3
1Cook County Health and Hospital Systems, Chicago, IL; 2University of Missouri Kansas City School of Medicine, Kansas City, MO; 3John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
Introduction: Burkitt’s lymphoma is an aggressively growing tumor commonly, involving the jaw and facial bones. A rare variant of this type of lymphoma is found in immunocompromised patients specifically in the gastrointestinal tract, usually affecting the stomach, distal ileum, and cecum and rarely the duodenum. We are reporting a case of primary lymphoma of the duodenum in a patient with newly diagnosed AIDS.
Case Description/Methods: A 50-years-old male with no significant past medical history presented with gradually progressive generalized weakness with easy fatigability of one-month duration. He had no history of shortness of breath, dysphagia, nausea, vomiting, hematemesis, melena, hematochezia or bleeding from any sites. Vitals were normal and examination was negative for abdominal tenderness, organomegaly or lymphadenopathy. Labs showed severe iron deficiency anemia with hemoglobin of 5.9 g/dl with ferritin of 21 ng/ml and Transferrin saturation of 8.8 %. Other labs including WBC count, platelets count, creatinine, liver enzymes and LDH were normal. In suspicious of occult gastrointestinal tract bleeding, upper endoscopy was performed revealing a large semi circumferential malignant appearing mass partially obstructing the lumen of the third portion of the duodenum. Multiple biopsied where taken showing small bowel mucosa infiltrated by uniform, intermediate sized cells strongly staining positive for CD10, CD20, Ki-67 (100%) and BCL-6; diagnostic for Burkitt’s lymphoma. CT Abdomen/Pelvis/Chest for evaluation of other masses or lymphadenopathy showed a 41 x 40 mm mass arising from the third and fourth portions of the duodenum with short segment wall thickening of the distal small bowel and soft tissue nodule in the right hemipelvis with no significant lymphadenoptahy. His labs reveleaed came positive for HIV-1 with 144,000 and CD4 count of 161. Bone marrow was negative for any involvement. He received 2 cycles of alternating chemotherapy with R-CODOX-M and R-IVAC for 4 months duration. PET scan after 2 month of chemotherapy completion was negative for any uptake. Patient is currently doing well, on HAART therapy with no recurrence of his symptoms.
Discussion: Primary duodenal Burkitt lymphoma is a subtype of non-Hodgkin's lymphoma and represents an aggressive and rare malignancy with only a small number of cases reported worldwide. Clinical and radiological presentation is non-specific and usually mimics other gastric lymphomas, leading usually to late presentation and diagnosis.
Citation: Mohamed A. Elkhouly, MD, MSc; Bashar M. Attar, MD, PhD; Ahmed A. Elkafrawy, MD; Miguel Salazar, MD; Ishaan Vohra, MD; Hemant Mutneja, MD; Oscar Rivas Chicas, MD. P0800 - BURKITT’S LYMPHOMA OF THE DUODENUM. Program No. P0800. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.