PMC4025053_01
CT scan of the abdomen showing diffuse asymmetric wall thickening of the pylorus and antrum (arrow).
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F1
The patient had an abdominal computed tomography (CT) scan showing diffuse asymmetric wall thickening of the pylorus and antrum of the stomach as well as of the first part of the duodenum (fig. 1).
Upper endoscopic view of a large friable ulcer occupying most of the gastric antrum.
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F2
He subsequently underwent esophagogastroduodenoscopy (EGD) revealing a large deep friable gastric ulcer with a clean base occupying about 75% of the antrum (fig. 2).
a Low-magnification view of the stomach ulcer (H&E stain, x100). Invasion of the gastric lamina propria by sheets of medium to large atypical lymphoid cells (asterisks), compared to uninvolved areas (arrow) with sparse reactive inflammatory infiltrates. b High-magnification view of the atypical lymphoid infiltrates (CD20 IHC stain, x200). Diffuse cytoplasmic staining of the atypical lymphocytic infiltrates (asterisks) for anti-CD20 marker, indicating B lymphocyte cell origin.
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F3
Multiple tissue biopsies were obtained and histopathology testing, with immunohistochemistry, confirmed the diagnosis of DLBCL (fig. 3).
Repeat CT scan of the abdomen post treatment. No visible thickening of the stomach wall (arrow).
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F4
The patient received a total of eight cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, etoposide and prednisolone (R-CHOEP). 14 months post treatment, the repeat lactate dehydrogenase level was 130 IU/l, while a CT scan of the abdomen revealed resolution of the previous gastroduodenal thickening (fig. 4).
Repeat endoscopic view post treatment. Normal appearance of the antrum and pylorus.
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F5
Follow-up EGD showed complete healing of the antral ulcer (fig. 5).
Low-magnification view of the previous ulcer site post treatment (H&E stain, x100). No histopathologic evidence of residual tumor.
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F6
Histopathology confirmed the patient's total remission of his gastric lymphoma (fig. 6).