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Tuesday Poster Session

Category: GI Bleeding

P4213 - Melena as the Initial Presentation of Diffuse Large B-Cell Lymphoma with Gastrointestinal Tract Involvement

Tuesday, October 29, 2024
10:30 AM – 4:00 PM ET
Location: Exhibit Hall E
Has Audio
Julie Lee, DO1, Faisal Mehmood, MD1, Gavin Levinthal, MD1, Mustafa Alani, MD2
1HonorHealth, Scottsdale, AZ; 2HonorHealth Medical Group, Chandler, AZ

Introduction: Diffuse large B-cell lymphoma (DLBCL) is characterized by the aggressive proliferation of large B lymphocytes. While DLBCL typically involves lymphoid tissues, extra nodal manifestations such as within the gastrointestinal (GI) tract are relatively common. However, GI bleeding as a presentation of DLBCL is rare. This case highlights the importance of considering DLBCL in the differential diagnosis when evaluating patients with unexplained GI bleeding.

Case Description/Methods: A 47-year-old male with no significant past medical history presented with a one-week history of left-sided abdominal pain, melena, and lightheadedness. Physical examination revealed a palpable mass in the right chest wall. Initial hemoglobin level was 9.8 g/dL. Computed tomography angiography (CTA) of the chest, abdomen, and pelvis revealed an invasive soft tissue mass of the anterior right mid-chest wall with rib invasion, right axillary chain adenopathy, and bulky mesenteric adenopathy within the left hemiabdomen, with significant surrounding inflammation and abutment and/or involvement of the adjacent jejunal loops; concerning for neoplastic disease involving the small bowel. The patient underwent an enteroscopy which showed no evidence of significant pathology in the examined duodenum and proximal jejunum. He underwent a biopsy of the right anterolateral chest wall mass with the pathology confirming diffuse large B-cell lymphoma. His symptoms of melena and acute blood loss anemia were attributed to involvement of the distal small bowel with lymphoma. Chemotherapy with rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) regimen was initiated.

Discussion: The GI tract is the most common site of extra-nodal lymphoproliferative neoplasms of the B-cell and T-cell lineage. Our literature review indicates that there is no prior report of GI bleeding as the initial presentation for DLBCL with GI tract involvement. This case highlights the importance of considering DLBCL in patients with unexplained GI bleeding, emphasizing the diverse clinical manifestations of this aggressive lymphoma.

Figure: Figure 1. CT imaging of anterior right mid-chest wall mass. Bulky enlargement of mesenteric lymph nodes within the small bowel mesentery of the left mid abdomen largest mass/node measuring 3.2 x 4.4 cm. Pathology of right chest wall mass depicting diffuse large B-cell lymphoma.


Disclosures:
Julie Lee indicated no relevant financial relationships.
Faisal Mehmood indicated no relevant financial relationships.
Gavin Levinthal indicated no relevant financial relationships.
Mustafa Alani indicated no relevant financial relationships.


Julie Lee, DO1, Faisal Mehmood, MD1, Gavin Levinthal, MD1, Mustafa Alani, MD2. P4213 - Melena as the Initial Presentation of Diffuse Large B-Cell Lymphoma with Gastrointestinal Tract Involvement, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.