eight fashion and cinched at end with closure of the ulcer bed (B). The ulcer bed was not visible after suturing and hemostasis was achieved (C). Repeat upper endoscopy after two weeks for nasojejunal feeding tube placement did not show presence of ulcer and any recurrent bleeding. Patient is being clinically optimized to resume chemotherapy. Discussion: To our knowledge, we describe herein the first case of successful use of endoscopic suturing for closure of a bleeding malignant gastric ulcer. We hypothesize that the thickened gastric folds secondary to the histologic nature of linitis plastica allowed for adequate tissue purchase at the margins of the bleeding gastric ulcer which would typically be precluded in malignant tissue due to its friable nature.[2797] Figure 1. A: Endoscopic image of gastric adenocarcinoma and associated cratered ulcer with oozing hemorrhage. B: Endoscopic image of suture device during closure. C: Endoscopic image of successful approximating edges of ulcer after endoscopic suturing without evidence of bleeding.

Case Description/Methods: A 67 year old man was noted to have a one centimeter smooth round lesion in his sigmoid colon on screening colonoscopy. The endoscopic appearance was consistent with a subepithelial lesion. A pillow sign was negative, showing a firm mobile mass. He was referred for endoscopic ultrasound. A radial echoendoscope was used to localize the lesion. It was round, well demarcated, hypoechoic, and originated in the fourth layer (muscularis propria). The radial scope was exchanged for a linear echoendoscope and FNA was performed using a 20 gauge biopsy needle. Pathology showed a spindle cell lesion that was positive for CD 117 staining consistent with a gastrointestinal stromal tumor. Multidiscipline discussion with colorectal surgery was had, and the decision to proceed with endoscopic resection using an over the scope clip to perform full thickness resection. Following the resection the patient had some post-procedure pain and was hospitalized for observation, treated with antibiotics, and serial imaging. No perforation was noted. Final pathology showed a 1.7cm low grade GIST with positive microscopic margins. Multidiscipline discussion at tumor board recommends continued surveillance for the low grade GIST. (Figure ) Discussion: Colonic GISTs are rare lesions with variable clinical courses. Full thickness endoscopic resection is an option using either an over the scope clip or dedicated full thickness resection device, or surgery are available options for management. Size, location, and multidiscipline discussion are needed to determine the best management strategy.[2827] Figure 1. 4th layer hypoechoic lesion, sigmoid colon.

Introduction: Non-Hodgkin lymphoma is classified as nodal and extranodal. Extranodal lymphoma frequently involves the stomach and is associated with H. Pylori infection. Colonic involvement, however, is rare. We present a case of MALT lymphoma that was found incidentally on colonoscopy. Case Description/Methods: A 73-year-old male with a history of diabetes presented for surveillance colonoscopy. Previous colonoscopy reports were unavailable, but the patient endorsed a history of benign polyps. Colonoscopy revealed a patchy area of inflammation and ulceration localized to the rectum and rectosigmoid colon. Biopsies demonstrated prominent lymphoid aggregates with inconclusive flow cytometry. He was referred to oncology who recommended further sampling. He underwent repeat colonoscopy 5 months later which demonstrated a 3 cm polyp in the cecum in addition to multiple segmental aphthae (uniform punctate lesions with surrounding erythema and central pallor) stretching from the distal sigmoid colon to the rectum. Pathology of the polyp demonstrated several lymphoid aggregates and rectosigmoid biopsies demonstrated prominent lymphoid aggregates that were positive for CD20, CD79a, BCL-2. Findings overall were consistent with extranodal marginal zone lymphoma. PET scan demonstrated diffuse lymphadenopathy, splenomegaly, and intense hypermetabolic activity throughout the colon. Stool studies were not obtained. The patient was recommended for chemotherapy with weekly rituximab which has been well tolerated to date. Discussion: Colorectal lymphoma is a rare occurrence, and represents less than 1% of all colorectal malignancies. Furthermore MALTomas present as primary colonic lymphomas in only 2.5% of cases. MALTomas predominate in men aged 50-70 years old and are associated with chronic immunosuppression and H. pylori infection when found in the stomach, although this does not necessarily hold true when found in the colon. Patients can present with symptoms of abdominal pain, obstruction, or GI bleeding. Endoscopic appearance of MALTomas is not well defined and can range from a single polypoid lesion to ulcerated mucosa or erosions. A combination of surgery, chemotherapy, and radiation is available for treatment of advanced disease.Primary colonic lymphoma is rare and there are only a few cases reported in the literature. Although rare, it is important to keep NHL in the differential when polypoid or ulcerated lesions are found on colonoscopy.

adenomas, 1 serrated and 2 hyperplastic polyps. However, histology of 4 polypoid appearing lesions (Figure 1A) showed prominent nodular atypical submucosal lymphoid aggregates (Figure 1B) that were positive for CD20, cyclin D1, weak CD5, and negative for CD10 and CD23. This was consistent with the diagnosis of MCL. CT imaging showed diffuse lymphadenopathy, including bulky disease with a 16.6 x 10.6 cm small bowel mesenteric mass (Figure 1C), along with proximal small bowel and terminal ileal thickening. He was induced with 6 cycles of bendamustine-rituximab combination therapy and maintained on rituximab. A re-staging scan at 27 months showed no evidence of disease progression. Discussion: We present a case of MCL presenting as MLP with symptoms of anemia, diarrhea and epigastric pain. MCL is a rare B-cell non-Hodgkin's lymphoma that portends a poor prognosis, making early identification and diagnosis critical. Obstruction, GI bleeding, and perforation are common complications for MCL presenting as MLP. It is important to keep MLP on the differential when multiple small nodular or polypoid lesions are identified on colonoscopy. All different types of polyps should be resected or sampled during colonoscopy, and each evaluated by the pathologist to avoid missing clinically significant conditions. Early diagnosis is key to prevent morbidity and mortality in MLP as described in our case.[2509] Figure 1. (A) polypoid lesion (B) nodular atypical submucosal lymphoid aggregates (C) 16.6 x 10.6 cm small bowel mesenteric mass.