S2945 Keeping Your Owl Eyes Open for Gastric Neoplasms: A Rare Case of Gastric Hodgkin’s Lymphoma

Abstract

INTRODUCTION: Gastric lymphomas (GL), cancers that originate within the stomach, are an uncommon condition that accounts for 15% of gastric malignancies and 2% of lymphomas. Approximately 90% of GLs are Non-Hodgkin's Lymphoma (NHL) usually MALT lymphomas and large B cell lymphomas. Hodgkin's lymphoma (HL) with stomach involvement is extremely rare and only few cases have been reported in the medical literature to date. CASE DESCRIPTION/METHODS: A 31-year-old young man with past medical history significant for HIV on HAART and recent diagnosis of Hodgkin’s lymphoma presented with fatigue, fever, night sweats and melena. Patient was found to have a Hgb of 3.4 and was admitted to the ICU for GI bleed. Physical exam revealed a distended abdomen with hepatomegaly and 1+ bilateral pitting edema in the lower extremities but negative for peripheral lymphadenopathy. Laboratory studies showed a Hgb of 3.4, BUN 22 and lactic acid of 4.6. Vital signs were significant for sinus tachycardia. Patient required 6 units of PRBCs. CT of the abdomen and pelvis was remarkable for mediastinal lymphadenopathy, bilateral pleural effusions and multiple low-density lesions in the liver and spleen along with massive retroperitoneal adenopathy. The patient underwent EGD which was remarkable for erosive gastritis, an 8mm ulcer with exudate in anterior wall of gastric antrum and a 1 cm ulcer with exudate in the lesser curvature of distal body of the stomach. The antral ulcer was biopsied and Reed Sternberg cells were detected under microscopy, cells were positive for CD30 on immunohistochemical staining but negative for CD 20/15 and 3. Hematology Oncology was consulted, and patient was started on cyclophosphamide with prednisone for cytoreduction of the tumor burden. Patient was diagnosed with rapidly progressing Stage 4B HL and palliative care was consulted. The patient and his family decided on inpatient hospice service with symptomatic chemotherapy treatments. DISCUSSION: Gastric Hodgkin’s Lymphoma is an extremely rare entity and only few cases have been reported in the medical literature to date. Most cases of gastric lymphoma are usually NHL. A definitive diagnosis is based primarily on EGD with gastric biopsy, the presence of Reed Sternberg cells under light microscopy and immunohistochemistry staining for CD 30.Figure 1Figure 2Figure 3