Moiz Ahmed1, Ahmed Al-Khazraji2, Umer Syed1, Tasur Seen1, Aaron Walfish1. 1. Division of Gastroenterology and Hepatology, Icahn School of Medicine At Mount Sinai (Elmhurst) Hospital, 79-01 Broadway, Elmhurst, NY, 11373, USA. 2. Division of Gastroenterology and Hepatology, Icahn School of Medicine At Mount Sinai (Elmhurst) Hospital, 79-01 Broadway, Elmhurst, NY, 11373, USA. alkhazra@nychhc.org.
Abstract
BACKGROUND: The gastrointestinal tract is sa well-known site for extranodal Non-Hodgkin lymphomas, with the stomach is known to be the most common site on lymphoma, primary gastric lymphoma (PGL). The lymphoproliferative disorder rarely occurs in patients with cirrhosis. We report a unique case of metastatic PGL in a patient with cirrhosis. CASE PRESENTATION: A middle-aged male with decompensated alcoholic cirrhosis presented with two weeks of epigastric abdominal pain, abdominal distension, and jaundice. Abdominal triple-phase CT scan was consistent with cirrhosis, ascites, and multiple new hypodense liver lesions classified as an intermediate probability for HCC based on the LI-RADS classification system (LI RADS 3). Due to the CT findings in the setting of cirrhosis, a provisional diagnosis of HCC was made. Upper endoscopy revealed new multiple umbilicated submucosal nodules in the gastric body. Biopsy and immunostaining consistent with high-grade B-cell lymphoma. Targeted liver biopsy with similar morphology and immunostaining profile consistent with metastatic primary gastric DLBCL. CONCLUSIONS: The case highlights the importance of recognizing metastatic PGL in patients with underlying cirrhosis to differentiate lymphoma from hepatocellular cancer. Targeted liver biopsies with lymphoma immunostaining are required to make a diagnosis.
BACKGROUND: The gastrointestinal tract is sa well-known site for extranodal Non-Hodgkin lymphomas, with the stomach is known to be the most common site on lymphoma, primary gastric lymphoma (PGL). The lymphoproliferative disorder rarely occurs in patients with cirrhosis. We report a unique case of metastatic PGL in a patient with cirrhosis. CASE PRESENTATION: A middle-aged male with decompensated alcoholic cirrhosis presented with two weeks of epigastric abdominal pain, abdominal distension, and jaundice. Abdominal triple-phase CT scan was consistent with cirrhosis, ascites, and multiple new hypodense liver lesions classified as an intermediate probability for HCC based on the LI-RADS classification system (LI RADS 3). Due to the CT findings in the setting of cirrhosis, a provisional diagnosis of HCC was made. Upper endoscopy revealed new multiple umbilicated submucosal nodules in the gastric body. Biopsy and immunostaining consistent with high-grade B-cell lymphoma. Targeted liver biopsy with similar morphology and immunostaining profile consistent with metastatic primary gastric DLBCL. CONCLUSIONS: The case highlights the importance of recognizing metastatic PGL in patients with underlying cirrhosis to differentiate lymphoma from hepatocellular cancer. Targeted liver biopsies with lymphoma immunostaining are required to make a diagnosis.
Entities:
Keywords:
Case report; Cirrhosis; Hepatocellular carcinoma HCC; Primary gastric lymphoma
Authors: Lindsay M Morton; Sophia S Wang; Susan S Devesa; Patricia Hartge; Dennis D Weisenburger; Martha S Linet Journal: Blood Date: 2005-09-08 Impact factor: 22.113
Authors: Bruce D Cheson; Richard I Fisher; Sally F Barrington; Franco Cavalli; Lawrence H Schwartz; Emanuele Zucca; T Andrew Lister Journal: J Clin Oncol Date: 2014-09-20 Impact factor: 44.544
Authors: S B Cogliatti; U Schmid; U Schumacher; F Eckert; M L Hansmann; J Hedderich; H Takahashi; K Lennert Journal: Gastroenterology Date: 1991-11 Impact factor: 22.682
Authors: Dimitrios Schizas; Ioannis Ntanasis-Stathopoulos; Diamantis I Tsilimigras; Athanasios D Sioulas; Demetrios Moris; Eleftherios Spartalis; Ilias Scotiniotis; Ioannis S Papanikolaou Journal: Gastroenterol Res Pract Date: 2017-03-16 Impact factor: 2.260