INFREQUENT EXTRA-NODAL MANIFESTATION OF A NON-HODGKIN'S LYMPHOMA

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Anaplastic large cell lymphoma (ALCL) is an aggressive type of Non-Hodgkin (NHL). Painless adenopathy and systemic symptoms are common but gastrointestinal (GI) involvement outside the liver rare. We report a case biopsy proven gastric distal small bowel ALCL. CASE PRESENTATION: 50-year-old male patient presented due to productive cough for two weeks, unintentional weight loss, oral ulcers maculo-papular rash in back. CT chest reported bilateral peri-bronchiolar "tree bud" appearance, right sided thin cavitary lesion hilar lymphadenopathy. Work up was negative fungal infections (including tuberculosis) allergic bronchopulmonary aspergillosis (ABPA). Sputum culture grew Pseudomona aeruginosa discharged on antibiotics. He returned dyspnea worsening skin lesions. On examination, he tachycardic hypoxemic room air; erythematous indurated papules with central necrosis were seen his palate trunk. These lesions biopsied, pathology ALK+ anaplastic lymphoma; Epstein-Barr virus (EBV) antibodies detected. Positive cytology from pleural fluid confirmed pulmonary involvement. developed melena; EGD revealed esophageal also consistent The course complicated by massive GI bleed bowel, resolved after IR catheterization celiac trunk hepatic artery. Despite antibiotics, became septic respiratory failure requiring intubation. Further chemotherapy contraindicated chose pursue home hospice. DISCUSSION: ALCL accounts approximately 2% all NHL. Although rare, it most form peripheral T lymphoma. It can present primary cutaneous or systemic, commonly involving skin, lungs, bones. Primary NHL usually affects liver; stomach intestine constitutes 1-4% cases has only been reports. speculated that EBV may be associated tumorigenesis; however no scientific evidence this fact. Anthracycline-based regimens followed consolidative autologous stem transplantation treatment choice, prognosis remains poor. CONCLUSIONS: Stomach intestinal involvements rare This illustrates myriad possible manifestations disease. REFERENCE #1: Delecluse HJ, Feederle R, O'Sullivan B, Taniere P. Epstein Barr virus-associated tumors: update attention working pathologist. J Clin Pathol. 2007;60(12):1358-1364. doi:10.1136/jcp.2006.044586 DISCLOSURES: No relevant relationships Hung-I Liao, source=Web Response Agata Parfieniuk, Valeria Trelles Garcia, Daniela