S6422 Primary Gastric Diffuse Large B-Cell Lymphoma Presenting With Recurrent Hematemesis

Introduction: Primary gastric lymphoma is an uncommon malignancy, accounting for approximately 3% of gastric cancers, with diffuse large B-cell lymphoma (DLBCL) being the most prevalent subtype. It typically occurs between ages 50–60, with a slight male predominance. Presenting symptoms are often vague, including epigastric pain, anorexia, early satiety, weight loss, or B symptoms. If bleeding occurs, it is usually occult. Overt gastrointestinal bleeding, particularly recurrent hematemesis, is a less common presentation. We report a striking case of primary gastric DLBCL in a young adult man who presented with recurrent hematemesis and was found to have multifocal deep gastric ulcers. Case Description/Methods: A 25-year-old man with no significant medical history presented with melena and multiple episodes of large-volume hematemesis. Laboratory evaluation revealed a hemoglobin drop from 13 g/dL to 8 g/dL, consistent with acute blood loss anemia. Esophagogastroduodenoscopy (EGD) showed approximately 10 deep, cratered ulcerative lesions, each 1–2 cm in size, distributed throughout the gastric fundus and body. None were actively bleeding. Endoscopic ultrasound (EUS) confirmed mucosal and submucosal involvement without deeper invasion. Biopsies revealed DLBCL, germinal center B-cell (GCB) subtype. Positron emission tomography (PET) scan demonstrated hypermetabolic lesions in the bilateral ribs without significant nodal or visceral involvement, consistent with primary gastric lymphoma with limited osseous spread. Due to recurrent hematemesis and transfusion-dependent anemia, the patient was admitted and started on chemotherapy with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone). He remains under close follow-up to assess response. Discussion: Recurrent, large-volume hematemesis is an uncommon presentation of gastric DLBCL. Endoscopic findings are variable and may include erythema, nodularity, mass lesions, or benign-appearing ulcers. The presence of numerous deep ulcerative lesions in the gastric body and fundus is atypical. This case underscores the importance of prompt endoscopic evaluation and histologic diagnosis in young patients with GI bleeding of unclear origin and highlights the need to include lymphoma in the differential.