Lin Y, Pan YH, Li MK, Zong XD, Pan XM, Tan SY, Guo YW. Clinical presentation of gastric Burkitt lymphoma presenting with paraplegia and acute pancreatitis: A case report. World J Gastroenterol 2021; 27(45): 7844-7854 [PMID: 34963746 DOI: 10.3748/wjg.v27.i45.7844]
Corresponding Author of This Article
Yun-Wei Guo, MD, PhD, Chief Doctor, Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou 510630, Guangdong Province, China. guoyw1973@hotmail.com
Research Domain of This Article
Oncology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Ying Lin, Ming-Kai Li, Xue-Mei Pan, Shu-Yan Tan, Yun-Wei Guo, Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
Yu-Hang Pan, Department of Pathology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
Xiao-Dan Zong, Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
Author contributions: Lin Y and Pan YH contributed equally to this work; Lin Y and Guo YW were the patient’s gastroenterologists; Pan YH performed the pathological diagnosis; Pan YH, Li MK, Zong XD, Pan XM, Tan SY contributed to the manuscript drafting; Zong XD performed the radiological diagnosis; Pan XM and Tan SY reviewed the literature; Lin Y, Guo YW and Pan YH were responsible for the revision of the manuscript for important intellectual content; and all authors issued final approval for the version to be submitted.
Supported byThe Science and Technology Planning Project of Guangzhou City, No. 201803010018.
Informed consent statement: The patient and his legal guardian provided informed written consent during the treatment.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yun-Wei Guo, MD, PhD, Chief Doctor, Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou 510630, Guangdong Province, China. guoyw1973@hotmail.com
Received: August 9, 2021 Peer-review started: August 9, 2021 First decision: August 29, 2021 Revised: September 11, 2021 Accepted: November 24, 2021 Article in press: November 24, 2021 Published online: December 7, 2021 Processing time: 115 Days and 16.9 Hours
Abstract
BACKGROUND
The incidence of gastric Burkitt lymphoma (BL), presenting as paraplegia and acute pancreatitis, is extremely low. BL is a great masquerader that presents in varied forms and in atypical locations, and it is prone to misdiagnosis and missed diagnosis. The prognosis of BL remains poor because of the difficulty in early diagnosis and the limited advances in chemotherapy.
CASE SUMMARY
A 53-year-old man was referred to our hospital from the local county hospital due to abdominal pain for two weeks and weakness in the lower extremities for one day. Magnetic resonance imaging of the abdomen and lumbar spine showed a swollen pancreas and gallbladder, with peripancreatic exudation and liquid collection, indicating acute pancreatitis and acute cholecystitis. Additionally, we observed abnormally thickened lesions of the gastric wall, multiple enlarged retroperitoneal lymph nodes and a well-demarcated, posterolateral extradural mass lesion between T9 and T12, with extension through the spinal foramen and definite bony destruction, suggesting metastasis in gastric malignancy. Subsequent whole-body positron emission tomography/computed tomography examination showed multifocal malignant lesions in the stomach, pancreas, gallbladder, bone, bilateral supraclavicular fossa, anterior mediastinum, bilateral axillary and retroperitoneal lymph nodes. Gastroduodenal endoscopy revealed primary BL with massive involvement of the gastric body and duodenum. The patient refused chemotherapeutic treatment and died one week later due to upper gastrointestinal hemorrhage. Afterward, we reviewed the characteristics of 11 patients with BL involving the stomach, pancreas or spinal cord.
CONCLUSION
Clinicians should be aware that BL can be the potential cause of acute pancreatitis or a rapidly progressive spinal tumor with accompanying paraplegia. For gastric BL, gastroscopy biopsies and pathology are necessary for a definite diagnosis.
Core Tip: The incidence of Burkitt lymphoma (BL) is extremely low, and the clinical symptoms are atypical. The misdiagnosis rate is high, and the patient's prognosis is poor. The patient in this case was eventually diagnosed with BL involving the stomach, pancreas and vertebral column presenting with acute pancreatitis and neurological symptoms secondary to compression of the spinal cord. Chemotherapeutic treatment was refused by the patient, and he eventually died after one week due to upper gastrointestinal hemorrhage. This case reminds us that further transcriptomic and clinical studies are needed to explore desirable biomarkers for early BL. Eleven cases were reviewed with an emphasis on diagnostic criteria and treatment protocols. Clinicians need to raise awareness of BL and reduce misdiagnosis rates.
