A Rare Case of Primary Hepatic B-cell Lymphoma and Upper Gastrointestinal Hemorrhage

Abstract

Diffuse large B-cell lymphoma (DLBCL) is the most common histologic subtype of non-Hodgkin lymphoma(NHL) accounting for approximately 25 % of all NHL cases. Extranodal extramedullary involvement occurs in up to 40% of cases. The most common site for extranodal extramedullary lymphoma is the stomach. Primary hepatic lymphoma is rare with a prevalence of 0.4% among extranodal NHL and 0016% among all NHLs. We hereby present a rare case of a 70-year old female with diffuse large B-cell lymphoma of the liver who had a metastasis to stomach resulting in a gastric ulcer. 70-year old female with a history of chronic hepatitis B infection, hypertension, recent admission for deep vein thrombosis (on Lovenox) and recently diagnosed via liver biopsy, of DLBCL of the liver presented to our hospital with episodes of melena and sharp epigastric pain after meals, for 1 week duration. The patient denied having any other complaints. Physical exam was unremarkable except distended abdomen with palpable epigastric abdominal mass and negative rectal exam. Lab results were significant for Hgb 7.1 of gm/dL, LDH of 2200 U/L, mildly elevated AST, ALT and ALP and normal total and direct bilirubin levels. Endoscopy was performed which revealed clean based ulcer of 6 mm x 4 mm in the body of stomach, with heaped margins and surrounding erythema with no signs of active bleeding, moderate size flat clean based duodenal bulb ulcer and sub-mucosal raised nodule of 6 mm x 3 mm in 2nd portion of the duodenum. Biopsy from gastric ulcer was determined to be positive for DLBCL with the similar pattern as seen in a Liver biopsy. Review of literature indicates that there are no reported cases of primary hepatic lymphoma presented with gastric ulceration and secondary gastrointestinal hemorrhage. Moreover, it should be known that the association found in the case presented carries morbidity and should be listed as part of a working differential in a patient with Hepatic B-Cell Lymphoma who are admitted with gastrointestinal hemorrhage.Figure