Upper digestive tract bleeding as a clinical presentation of non-Hodgkin's lymphoma

Main Article Content

René Medina-Marroquín http://orcid.org/0000-0001-6764-0115
Iván González-Godínez http://orcid.org/0000-0003-0917-638X
Carlos de Jesús Maldonado-López http://orcid.org/0000-0001-9097-8472
Ana Cristina Calzada-Rascón http://orcid.org/0000-0002-7409-7832

Keywords

Hematology, Hemorrhage, Rheumatoid Arthritis, Lymphoma

Abstract

Background: Non-Hodgkin's lymphoma (NHL) is a group of malignant tumors of the nodal and extranodal lymphoid tissues, and it is associated with autoimmune diseases, mainly rheumatoid arthritis (RA). Extra nodal presentation is observed in 40%, mainly affecting the gastrointestinal tract in 3% of cases, with bleeding in the digestive tract being a rare cause of clinical presentation that requires a detailed diagnostic approach.


Clinical case: 55-year-old female with a history of RA, admitted to an internal medicine service due to bleeding in the digestive tract; patient presented clinical data of deep vein thrombosis in the left pelvic limb and consumptive syndrome under study. During her approach she was identified with splenic and liver infarctions, as well as multiple lymph node conglomerates, due to which it was performed an axillary lymph node biopsy reporting neoplastic proliferation of lymphoid cells, and bone marrow aspirate with presence of lymphoplasmacytic infiltration, with which a diagnosis of stage IV non-Hodgkin lymphoma was made. Patient was sent to a third-level hospital to start treatment.


Conclusions: This case shows us what has already been described in literature, which is why it is of fundamental importance to carry out a comprehensive approach of clinical findings in patients with previously identified risk factors, with the aim of achieving an etiological diagnosis that allows early therapy to improve their survival.

Abstract 53 | PDF (Spanish) Downloads 28

References

Armitage JO, Weisenburger DD. New approach to classifying non-Hodgkin's lymphomas: clinical features of the major histologic subtypes. Non-Hodgkin's Lymphoma Classification Project. J Clin Oncol. 1998;16(8):2780-95. doi: 10.1200/JCO.1998.16.8.2780.

Andrews CN, John-Gill M, Urbanski SJ, et al. Changing epidemiology and risk factors for gastrointestinal non-Hodgkin's lymphoma in a North American population: population-based study. Am J Gastroenterol. 2008;103(7):1762-9. doi: 10.1111/j.1572-0241.2008.01794.x.

Howell JM, Auer-Grzesiak I, Zhang J, et al. Increasing incidence rates, distribution and histological characteristics of primary gastrointestinal non-Hodgkin lymphoma in a North American population. Can J Gastroenterol. 2012;26(7):452-6. doi: 10.1155/2012/480160.

Valdés-Díaz KC, Hernández-Negrin H, López-Sacerio A, et al. Enfermedad linfoproliferativa asociada a artritis reumatoide: reporte de tres casos. Rev Cuba Reumatol. 2019;(Suppl 1):e7621. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1817-59962019000400014&lng=es.

Villela L, Hernández-Hernández JA, López-Sánchez R, et al. Inmunología y Linfoma: Dos conceptos que siempre estarán unidos. Rev Hematol Mex. 2019;20(2):65-7.

Ramos-Casals M, la-Civita L, de-Vita S, et al. Characterization of B cell lymphoma in patients with Sjögren's syndrome and hepatitis C virus infection. Arthritis Rheum. 2007;57(1):161-70. doi: 10.1002/art.22476.

Itoh K, Patki V, Furie RA, et al. Clonal expansion is a characteristic feature of the B-cell repetoire of patients with rheumatoid arthritis. Arthritis Res. 2000;2(1):50-8.

Cardona DM, Layne A, Lagoo AS. Lymphomas of the gastro-intestinal tract - pathophysiology, pathology, and differential diagnosis. Indian J Pathol Microbiol. 2012;55(1):1-16. doi: 10.4103/0377-4929.94847.

Tian Y, Li C, Tian R, et al. T-Cell Non-Hodgkin Lymphoma of the Ileum Presenting as Perforation and Peritonitis: A Case Report. Front Surg. 2022;9:810360. doi: 10.3389/fsurg.2022.810360.

Dawson IM, Cornes JS, Morson BC. Primary malignant lymphoid tumours of the intestinal tract. Report of 37 cases with a study of factors influencing prognosis. Br J Surg. 1961;49:80-9. doi: 10.1002/bjs.18004921319.

Telci-Caklili O, Mutlu HH, Colak Y, et al. Massive Upper Gastrointestinal Bleeding Caused by Diffuse Large B-Cell Lymphoma. Case Rep Gastrointest Med. 2016;2016:5079709. doi: 10.1155/2016/5079709.

Kim MS, Park JH, Kim JY, et al. Upper gastrointestinal bleeding caused by direct invasion of diffuse large B-cell lymphoma into the stomach in a patient with HIV infection: A case report. Medicine (Baltimore). 2019;98(28):e16363. doi: 10.1097/MD.0000000000016363.

Alvarez-Lesmes J, Chapman JR, Cassidy D, et al. Gastrointestinal Tract Lymphomas. Arch Pathol Lab Med. 2021;145(12):1585-96. doi: 10.5858/arpa.2020-0661-RA.

Honda M, Furuta Y, Naoe H, et al. Primary mucosa-associated lymphoid tissue (MALT) lymphoma of the gallbladder and review of the literature. BMJ Case Rep. 2017;2017:bcr2017220161. doi: 10.1136/bcr-2017-220161.

Gralnek IM, Stanley AJ, Morris AJ, et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2021. Endoscopy. 2021;53(3):300-32. doi: 10.1055/a-1369-5274.

Kim DH, Lee D, Kim JW, et al. Endoscopic and clinical analysis of primary T-cell lymphoma of the gastrointestinal tract according to pathological subtype. J Gastroenterol Hepatol. 2014;29(5):934-43. doi: 10.1111/jgh.12471.

Balanzá R, Somerville N, Rojas-Mendoza F, et al. Características endoscópicas del linfoma gástrico primario. Endoscopia. 2020;32(1):7-13.

Koch P, del-Valle F, Berdel WE, et al. Primary gastrointestinal non-Hodgkin's lymphoma: I. Anatomic and histologic distribution, clinical features, and survival data of 371 patients registered in the German Multicenter Study GIT NHL 01/92. J Clin Oncol. 2001;19(18):3861-73. doi: 10.1200/JCO.2001.19.18.3861.

Wang T, Gui W, Shen Q. Primary gastrointestinal non-Hodgkin's lymphoma: clinicopathological and prognostic analysis. Med Oncol. 2010;(3):661-6. doi: 10.1007/s12032-009-9265-1.

Yamashita H, Izutsu K, Nakamura N, et al. Treatment results of chemoradiation therapy for localized aggressive lymphomas: A retrospective 20-year study. Ann Hematol. 2006;85(8):523-9. doi: 10.1007/s00277-006-0114-4.

Wang YG, Zhao LY, Liu CQ, et al. Clinical characteristics and prognostic factors of primary gastric lymphoma: A retrospective study with 165 cases. Medicine (Baltimore). 2016;95(31):e4250. doi: 10.1097/MD.0000000000004250.

Martelli M, Ferreri AJ, Agostinelli C, et al. Diffuse large B-cell lymphoma. Crit Rev Oncol Hematol. 2013;87(2):146-71. doi: 10.1016/j.critrevonc.2012.12.009.

Fischbach W. Gastric MALT lymphoma - update on diagnosis and treatment. Best Pract Res Clin Gastroenterol. 2014;28(6):1069-77. doi: 10.1016/j.bpg.2014.09.006.

Klein A, Polliack A, Gafter-Gvili A. Rheumatoid arthritis and lymphoma: Incidence, pathogenesis, biology, and outcome. Hematol Oncol. 2018;36(5):733-9. doi: 10.1002/hon.2525.

Shum JB, Jayaraman S, Croome K, et al. Upper gastrointestinal and intra-abdominal hemorrhage secondary to diffuse large B-cell gastric lymphoma. Can J Surg. 2008;51(3):E56-7. Disponible en: https://www.canjsurg.ca/content/51/3/E56.long.

Coiffier B, Lepage E, Briere J, et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med. 2002;346(4):235-42. doi: 10.1056/NEJMoa011795.