Aggressive Burkitt-Like Lymphoma of Colon in a Patient With Prior Celiac Disease
A 75-year-old man with history of celiac disease presented with pallor, fatigue, and 20-pound weight loss of three weeks duration. CD was diagnosed two years prior, at which point the patient underwent extensive evaluation for unexplained microcytic hypochromic anemia and was found to have an elevated endomysial antibody titer. A small bowel biopsy showed celiac disease. The patient was then placed on a gluten-free diet and the anemia resolved completely.\nOn physical examination, a vague non-tender mass in the right hypochondrium was found and his stools tested positive for occult blood. The laboratory values were within normal range, except for hemoglobin (11mg/dL), MCV 75, SGOT (61 IU/L) and LDH (5000 IU/L).\nCT scan of abdomen showed extensive carcinomatosis. There were also small pleural effusions and scattered lymphadenopathy. PET showed diffusely hyper-metabolic foci coinciding with CT findings. Colonoscopy revealed a friable nodular mass in the hepatic flexure and proximal transverse colon. However, histopathologically the mass consisted of a high-grade B-cell lymphoma. Flow cytometry following immunostaining reported positive CD10, CD19, CD20, CD45, CD79a, and Ki-67. FISH assay demonstrated t (14:18) translocation and bcl-2 rearrangement. The bone marrow biopsy showed evidence of disease []. The bone marrow biopsy was also positive for CD10, CD19, CD20, CD38, CD45 and HLA-DR.\nThe patient was treated with rituximab cyclophosphamide, Adriamycin, vincristine, and prednisone (CHOP-R) according to protocol, with intrathecal methotrexate prophylaxis. The patient is currently in remission.