Gastroduodenal Burkitt´s lymphoma in an immunocompetent patient.

The stomach is the most frequent site of extranodal malignant lymphomas. The most common gastric lymphomas are mucosa-associated lymphoid tissue (MALT) and diffuse large B cell lymphomas. Burkitt’s lymphoma is a highly aggressive non-Hodgkin lymphoma. In the sporadic form, patients usually present with abdominal disease, with involvement of the distal ileum, cecum and mesentery. Although the true incidence of gastroduodenal Burkitt lymphoma is not yet defined, non-endemic gastroduodenal Burkitt’s lymphoma is rare in non-HIV adult population. We report a case of gastroduodenal involvement by Burkitt lymphoma in an immunocompetent patient, previously healthy, who presented with persistent epigastric pain, cervical swelling, horizontal diplopia and paresthesias. Viral markers were negative. On upper endoscopy, multiple raised ulcerated nodules, some with central depression were observed on the greater curvature of the gastric body and antrum, and numerous smaller nodules were present in the second and third part of the duodenum. Gastric and duodenal biopsies showed expansion of the lamina propria by a diffuse infiltrate of neoplastic lymphoid cells of intermediate/ large size, predominantly regular nuclei with dispersed chromatin, high mitotic index and signs of apoptosis. On immunohistochemistry, tumour cells showed positive staining for CD20 and CD10. Helicobacter pylori infection was not detected. Induction chemotherapy with intrathecal chemotherapy was preformed with improvement of neurologic and digestive symptoms.