SHM Converge Scientific Abstract ePoster Gallery-Gastric Outlet Obstruction as the First Sign of Large B-Cell Lymphoma: A Diagnostic Dilemma in the Presence of a Retroperitoneal Mass

Gastric Outlet Obstruction as the First Sign of Large B-Cell Lymphoma: A Diagnostic Dilemma in the Presence of a Retroperitoneal Mass

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This case describes a 68-year-old man who presented with progressive abdominal distension and discomfort, later developing nausea and non-bilious vomiting. Initial evaluation showed elevated LDH, hyperuricemia, and hypercalcemia, raising concern for a hematologic malignancy. CT imaging revealed a large retroperitoneal soft tissue mass encasing major vessels and appearing possibly renal in origin, with associated gastric and proximal duodenal dilation suggesting gastric outlet obstruction (GOO).<br /><br />A core biopsy clarified the diagnosis as diffuse large B-cell lymphoma (DLBCL). The patient then developed worsening obstructive symptoms from extrinsic compression of the duodenum by the lymphoma. He was managed supportively with nasogastric decompression and total parenteral nutrition, and then started on R-CHOP chemotherapy. His symptoms gradually improved, and the nasogastric tube was eventually removed.<br /><br />Pathology from the duodenal biopsy showed diffuse infiltration by atypical lymphoid cells, with CD20 positivity confirming B-cell lineage. Fluorescence in situ hybridization (FISH) demonstrated a BCL6 gene rearrangement.<br /><br />The report highlights that GOO is a rare presentation of DLBCL, accounting for only a small fraction of malignant GOO cases. Because this presentation can mimic more common solid tumors such as renal, gastric, or pancreatic cancers, clinicians should consider lymphoma in patients with obstructive symptoms and retroperitoneal masses, especially when laboratory findings suggest high tumor burden or hematologic disease. Early tissue diagnosis and prompt initiation of chemotherapy are key, as R-CHOP is the main treatment and usually leads to resolution of the obstruction without the need for surgery.

Asset Subtitle

Komlan E. Guedze

Meta Tag

Author List Erica Frankie Pizzi, Kojo-Frimpong B. Awuah,, Komlan E. Guedze, Nicholas Jaeger, Shuaib Okponobi, Tyrell Daniel

Category Clinical Vignettes

Concept Gastric Outlet Obstruction

Concept Diffuse Large B-Cell Lymphoma

Concept R-CHOP

Concept Tissue Biopsy

Concept Extrinsic Compression

Distinguished Non-Finalist

Presenter Organization Franciscan Health Olympia Fields

Presenting Author Komlan E. Guedze

Track Adult

Keywords

diffuse large B-cell lymphoma

DLBCL

gastric outlet obstruction

retroperitoneal mass

duodenal compression

R-CHOP chemotherapy

CD20 positivity

BCL6 rearrangement

hyperuricemia

hypercalcemia

Gastric Outlet Obstruction

Diffuse Large B-Cell Lymphoma

R-CHOP

Tissue Biopsy

Extrinsic Compression