Burkitt’s Lymphoma of the Rectosigmoid and Stomach Presenting as Hematochezia

Abstract

Patient: Female, 51Final Diagnosis: Burkitt’s lymphoma of the rectum and stomachSymptoms: HematocheziaMedication: —Clinical Procedure: EGD and colonoscopySpecialty: Gastroenterology and HepatologyObjective:Rare diseaseBackground:Burkitt’s lymphoma (BL) is an uncommon cause of non-Hodgkin lymphoma in adults and accounts for only 0.1–0.5% of all malignant tumors of the colon and rectum. Very few cases of rectosigmoid and stomach BL have been reported in adults.Case Report:A 51-year-old Hispanic woman presented with a 1-month history of hematochezia, associated with a foreign-body sensation in the rectum and 7 kg weight loss. Initial laboratory workup showed normocytic anemia and positive fecal occult blood. Computed tomography of the abdomen revealed an asymmetric appearance of the stomach and pylorus with nodularity of the mucosa and thickening of the posterior wall, and a 10.8-cm rectal mass. Esophagogastroduodenoscopy and colonoscopy were performed and biopsies of the stomach and rectum were obtained; histopathology demonstrated involvement by Burkitt’s lymphoma in the gastric body nodule and rectal mass. After 4 cycles of chemotherapy, a follow-up abdominal CT demonstrated complete resolution of the mural thickening of the rectum and no intra-abdominal lymphadenopathy.Conclusions:Our case illustrates the importance of considering BL in the extensive differential diagnosis of rectal bleeding, change in bowel habits, and other lower and upper GI symptoms, since the rapidly growing nature of this rare malignancy requires a prompt diagnosis and initiation of appropriate therapy.

Burkitt’s Lymphoma of the Colon: A Case Report and Review of the Texas Cancer Registry

“…Therefore, primary lymphoma of the colon is very rare, comprising only 0.1-0.5% of all colonic malignancies [5,6]. Published reports of sporadic BL present evidence of its GI involvement, but very few reports have described primary colonic findings in the immunocompetent adult population [1,2,5].…”

“…Burkitt's lymphoma (BL) is a highly aggressive non-Hodgkin's B-cell lymphoma (NHL) recognized by three epidemiological forms: endemic, sporadic, and immunodeficiency-associated. Endemic BL cases are seen in equatorial Africa among children presenting with facial tumors [1,2]. Immunodeficiency-associated BL has been reported in AIDS cases and transplant recipients on immunosuppressors [1][2][3].…”

“…Endemic BL cases are seen in equatorial Africa among children presenting with facial tumors [1,2]. Immunodeficiency-associated BL has been reported in AIDS cases and transplant recipients on immunosuppressors [1][2][3]. The sporadic form of BL is seen in the United States and Western Europe and comprises <1% of adult NHL in the United States.…”

“…Though there are reports of extranodal spread, primary NHL of the colon is an extremely rare case, encompassing only 0.1-0.5% of all malignant tumors of the colon [1]. Sporadic BL may be misdiagnosed due to its rarity and non-specific GI presentation.…”

An unusual cause of large bowel obstruction: are we aware of this?

“…On the other hand, immunodeficient variant has been reported in patients suffering from human immunodeficiency virus (HIV), in solid organ recipients as well as in patients with congenital immunodeficiency diseases. Presentation in elderly and adult population is quite rare with few cases reported in the medical literature [ 3 ]. Herein, we describe a case of a 63-year old patient who presented in the emergency department with signs of large bowel obstruction, underwent curative surgery and found to suffer from BL of the ileocecal region.…”