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Corresponding author at: Division of Gastroenterology, Department of Internal Medicine, Sapporo Shirakaba-dai Hospital, 2-18 Tsukisamu-Higashi, Toyohira-ku, Sapporo 062-0052, Japan.
Division of Gastroenterology, Department of Internal Medicine, Sapporo Shirakaba-dai Hospital, Sapporo, JapanDepartment of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
A 61-year-old woman without noted medical history was admitted with hematemesis. Laboratory
findings showed anemia, liver dysfunction, and high soluble IL-2 receptor. Esophagogastroduodenoscopy
revealed multiple gastric tumors, including a large ear-shaped ulcer with an exposed
vessel in the posterior wall and a IIa+IIc lesion (Fig. 1a-c). Endoscopic hemostasis was successfully performed. Endoscopic ultrasonography
revealed hypoechoic lesions (Fig. 1d). CT revealed multiple liver metastases (Fig. 1e). Gastric biopsy specimens showed diffuse infiltration of small non-cleaved cells
(Fig. 2a,b). Immunohistochemical examination showed that more than 90% of tumor cells were
positive for MIB-1, along with positive for CD10, CD20, and c-Myc, but negative for
CD3, bcl-2, and EBER1 (Fig. 2c-f). In situ hybridization revealed positive results for Myc/IgH fusion. Sporadic-type
Burkitt lymphoma (BL) was therefore diagnosed. She received an R-hyper CVAD/MA regimen
(rituximab and cyclophosphamide, vincristine, doxorubicin, dexamethasone/methotrexate,
cytarabine) and achieved complete remission, but died of pneumonia 3 months after
admission. Autopsy revealed complete remission of both the primary gastric lesions
and liver metastases.
Fig. 1(a-c) Esophagogastroduodenoscopy showed multiple gastric tumors, including a large
ear-shaped ulcer with an exposed vessel in the posterior wall of the upper body (a,b)
and a IIa+IIc lesion at the greater curvature of the middle body (c). (a,b) Endoscopic
hemostasis was successfully performed with local injection of ethanol and hemoclipping.
(d) Endoscopic ultrasonography revealed that a large ear-shaped ulcer (a,b) was hypoechoic
lesion from the submucosa to the muscularis. (e) CT showed multiple liver metastases.
