JEJUNAL AND ADRENAL LYMPHOMA PRESENTING AS A GI BLEED: A CASE REPORT

Objectives: GI lymphomas are relatively rare accounting for only 1-4% of GI malignancy. The most common site of GI lymphoma is overwhelmingly the stomach with less than 10 percent occurring in the small bowel. GI lymphomas present with a variety of symptoms including early satiety, vague abdominal pain, B symptoms, but very rarely as a GI bleed. Adrenal incidentalomas are a common occurrence, but rarely due to lymphoma. Here we present a case of a 70 year old male who presented to the hospital with symptomatic anemia and melanotic stools. He was noted to have a hemoglobin of 5.1 on admission. He received 4 u PRBC over three days and responded well with an increase in hgb to 9.0. Gastroenterology was consulted who performed EGD and colonoscopy which revealed no abnormalities. Capsule endoscopy showed a suspicious lesion with possible ulceration in the jejunum. CT enterography was obtained and confirmed the presence of a jejunal mass as well as a 7.5 x 5.4 x 5.4 cm left adrenal mass concerning for mass concerning for malignancy. Urine and plasma metanepherines were obtained and within normal limits. The patient was then taken to the operating room where he underwent open small bowel resection with left adrenalectomy via a left subcostal incision. Patient tolerated the procedure well. Pathology returned and revealed diffuse large B cell lymphoma in both the adrenal gland and jejunum. 16 nodes in the jejunal specimen showed signs of disease. On post operative day 4 the patient underwent port placement and was discharged home on postoperative day 5 with medical oncology follow up for adjuvant chenmotherapy. The patient underwent and tolerated chemotherapy. Post treatment CT scans and lab work have shown no signs of recurrence, and the patient remains in remission 13 months postoperatively. This is an extremely rare presentation of abdominal lymphoma. Although lymphoma is generally quite responsive to chemotherapy, surgical resection does play a role when indications such as bleeding or obstruction are present. Surgery can also play a role in abdominal lymphoma when tissue diagnosis is necessary in situations such as this adrenal mass with concerning features.

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