S6330 An Unusual Cause of Melena: A Rare Case of Primary Gastric Burkitt’s Lymphoma Presenting as a Bleeding Gastric Ulceration

Introduction: Burkitt lymphoma (BL) is an aggressive non-Hodgkin lymphoma driven by MYC gene translocation. It has 3 subtypes: endemic, sporadic, and immunodeficiency associated. While BL often involves the ileocecal region, primary gastric Burkitt lymphoma (PGBL) is rare and accounts for a small subset of gastrointestinal lymphomas. Here, we present a 64-year-old man who presented with epigastric pain, melenic stools, blood loss anemia and found to have PGBL as a bleeding gastric ulcer. Given its aggressive course, early recognition and prompt chemotherapy are crucial for remission. Case Description/Methods: A 64-year-old man with past medical history significant for peptic ulcer disease initially presented to the emergency department with complaints of melena and epigastric pain for a duration of 2 to 3 days. Computed tomography (CT) abdomen showed findings suggestive of gastritis and a possible ulcer along the lesser curvature of the stomach with nonspecific low-grade lymphadenopathy involving the gastrohepatic lymph nodes. Esophagogastroduodenoscopy (EGD) showed a single large, irregular, and cratered malignant-appearing ulcer within the distal lesser body of the stomach measuring 3 × 10 cm. The pathology of the biopsied specimen showed a monotonous proliferation of neoplastic cells obliterating the normal gastric architecture with tingible body macrophages creating the classic “starry sky” appearance. Biopsy samples from the ulcer showed atypical proliferation of large B-cells with aberrant CD10 and BCL-6 expression, along with fluorescent in situ hybridization testing showing rearrangement of MYC;IgH t (8;14).The patient was subsequently started on R-EPOCH chemotherapy. Discussion: Burkitt’s lymphoma with primary gastric manifestation can be a cause for ulcerative lesions and upper gastrointestinal bleeding. The 2 main histological subtypes of primary gastric Burkitt’s lymphoma include diffuse large B-cell lymphomas and mucosa-associated lymphoid tissue lymphomas. PGBL presents nonspecifically, often mimicking peptic ulcer disease, gastritis, or gastric adenocarcinoma. Symptoms include abdominal pain, nausea, gastrointestinal bleeding, or, in advanced cases, perforation. Diagnosis requires histopathology and immunohistochemistry due to variable endoscopic findings. One defining characteristic of Burkitt’s lymphoma is the chromosomal translocation between the Myc proto-oncogene and 1 of 3 immunoglobulin genes. Immediate intervention with R-EPOCH chemotherapy is recommended for 5 cycles.