Primary Gastric Anaplastic Lymphoma Kinase (ALK) Negative, Large-Cell Lymphoma Causing Gastrointestinal Bleeding in a Patient With Roux-en-Y Gastric Bypass

Abstract

Introduction: Anaplastic large cell lymphoma (ALCL) is a rare, CD30 positive T-cell neoplasm accounting for 3% of all non-Hodgkin’s lymphomas. Primary lesions are rarely found in the gastrointestinal (GI) tract. Patients may present with dyspepsia, bleeding, etc. Treatment usually requires resection with adjuvant chemotherapy. Even with treatment, the anaplastic lymphoma kinase negative (ALK-negative) variant has a 30-49% 5-year survival rate. This is the case of a 54-year-old female with a history of Rouxen-Y gastric bypass presenting with severe GI bleeding due to reoccurrence of a primary ALK-negative ALCL tumor in the gastric remnant. This lead to hemorrhagic ischemic necrosis, perforation, and splenic invasion, requiring surgical intervention. Remnant perforation is rare, reported mainly in case reports. Endoscopy should be performed to rule out anastomotic ulcerations, and deep enteroscopy if remnant bleeding is suspected. Increased understanding of a bariatric patient’s altered anatomy and adequate cancer surveillance may improve outcomes if complications are recognized early on in these patients.Figure 1: Anastomotic ulcer actively bleeding.Figure 2: Anastomotic ulcer after hemostasis.Figure 3: Immunohistochemical stain for CD30 showing infiltrative cells in the splenic tumor section.