Gastric Perforation: Unusual Presentation of Gastric Lymphoma in Pediatric Population

Submit Manuscript | http://medcraveonline.com and spleen with suspected perforation of the stomach (Figure 1: A: Pneumoperitoneum and Ascites. B: Suspected Gastric perforation). Patient underwent urgent laparotomy; gastric perforation was found and repaired. Gastric biopsies were done. Patient kept having fever post-operatively with distended and tender abdomen, abdomen/pelvis CT was repeated to rule out any abscess collection, and showed moderate amount of fluid in the abdomen, mainly anterior to the left colon. Collections showed compartmentalization, a CTguided drainage done and 100cc of fluid were obtained and culture grew after 48 hours in Leuconostoc and streptococcus mitis so Ceftazidime and Metronidazole were switched to Imipenem/Cilestatin. On Day 5 post-op, patient started to have severe abdominal pain with tachypnea and desaturation; abdomen/pelvis CT showed large amount of fluid in the peritoneal cavity, associated with thickening of the parietal peritoneum and re-perforation was suspected. Patient underwent urgent laparotomy where clear fluid was obtained, drain was placed, and biopsies from the liver, omentum and spleen were performed. Immunohistological examination of the gastric biopsies revealed an abnormal T cell lymph proliferation in favor of non-Hodgkin’s T-cell lymphoma (Figure 2: Histopathology of the Gastric Biopsies. A: Low power view from ulcer base showing a diffuse infiltrate involving the full thickness of the gastric wall (H&E x 40). B: Diffuse monotonous infiltrate involving the vessel wall (H&E x 100). C: Medium sized convoluted nuclei with clear cytoplasm and scattered eosinophils (H&E x 400). D: Diffuse membranous positivity of tumor cells with anti-CD3 (IHC x 400). E: Staining with anti-CD20 shows negative tumor cells with positive residual germinal center. Few glandular Lumina with effaced epithelial lining are seen in the middle (IHC x 400). )