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Primary gastric Burkitt lymphoma with multiple hepatic metastases

  • Hiroaki Mita
    Affiliations
    Division of Gastroenterology, Department of Internal Medicine, Sapporo Shirakaba-dai Hospital, Sapporo, Japan
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  • Yasushi Adachi
    Correspondence
    Corresponding author at: Division of Gastroenterology, Department of Internal Medicine, Sapporo Shirakaba-dai Hospital, 2-18 Tsukisamu-Higashi, Toyohira-ku, Sapporo 062-0052, Japan.
    Affiliations
    Division of Gastroenterology, Department of Internal Medicine, Sapporo Shirakaba-dai Hospital, Sapporo, Japan

    Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
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  • Yoshifumi Ishii
    Affiliations
    Pahology, Sapporo Shirakaba-dai Hospital, Sapporo, Japan
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  • Takao Endo
    Affiliations
    Division of Gastroenterology, Department of Internal Medicine, Sapporo Shirakaba-dai Hospital, Sapporo, Japan
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Published:September 14, 2022DOI:https://doi.org/10.1016/j.dld.2022.08.037
      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
      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.
      Fig. 2
      Fig. 2Pathological examinations. (a,b) Gastric biopsy specimens showed diffuse infiltration of small non-cleaved cells. (b) Magnified view of (a). (c-f) Immunohistochemical examination revealed positive for CD20 (c), CD10 (d), and c-Myc (e), but negative for bcl-2 (f).
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