A case of nodal malignant lymphoma presenting with arterial bleeding related to its duodenal penetration

Abstract

A 62-year-old man with a chief complaint of dysphagia visited our hospital. Enhanced computed tomography showed the tumor near the duodenal wall and lymphadenopathy in the left supraclavicular fossa and para-aortic lymph node. Upper gastrointestinal endoscopy showed an ulcer accompanied with a fistula in the anterior wall of duodenal bulb, suggesting that the tumor penetrated into duodenal wall. Biopsy from the lymph node in the left supraclavicular fossa indicated diffuse large B-cell lymphoma. Although chemotherapy was planned, massive arterial bleeding occurred from the part of duodenal penetration. Endoscopic hemostasis was unsuccessfully performed. Therefore, we performed transcathether arterial embolization for hemostasis. After the procedure, the patient received six cycles of chemotherapy, and he achieved complete response. He has been alive 5 years without recurrence. There were many cases of gastrointestinal bleeding from primary gastrointestinal lymphomas, while there were few cases with nodal involvement by malignant lymphoma resulting in bleeding from gastrointestinal tract. We herein report a case of duodenal bleeding by nodal involvement of diffuse large B-cell lymphoma with review of literature.

Successful hemostasis for arterial bleeding in duodenal malignant lymphoma using reopenable clip

“…In gastrointestinal malignant lymphoma, gastrointestinal bleeding is observed in only 3% of cases 1 . Bleeding from the tumor is difficult to stop endoscopically, and cases of vascular embolization and irradiation have been reported 2,3 . Recently, reopenable clips have been effective for uncontrolled bleeding in gastric endoscopic submucosal dissection 4 and prevention of bleeding after endoscopic papillectomy 5 .…”

<p>Splenic Diffuse Red Pulp Small B-Cell Lymphoma with Gastrointestinal Hemorrhage: A Case Report and Literature Review</p>

“… 12 Digestive tract lymphoma may occur in the intestinal tract or other parts of the lymphoma invasion. 12 – 15 Whereas, there are few reported cases of SDRPSBCL with digestive tract symptoms such as hemoptysis or hematochezia, the relationship between SDRPSBCL with GIH symptom and the outcomes of treatment. In this paper, a case of SDRPSBCL complicated with GIH was analyzed retrospectively and the treatment was followed up.…”