PMC6968688_01
Computed tomography of the abdomen and pelvis with intravenous contrast displaying gastric antral wall thickening (arrows), diffuse omental infiltration, and linitis plastica.
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By hospital day 5, the patient showed no improvement, and a repeat CT of the abdomen and pelvis with intravenous contrast was performed, which showed persistent gastric antral wall thickening and narrowed lumen suspicious for gastric malignancy, diffuse omental infiltration, and concerns for linitis plastica (Figure 1).
Computed tomography enterography showing jejunal inflammation with edema.
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Along with the multifocal liver lesions, moderate ascites, and distinctive reticular infiltration of the omentum also seen on CT, this was highly suggestive of enteropathic non-Hodgkin's lymphoma (Figure 2).
Direct visualization of the GI tract by push enteroscopy, showing abnormal proximal jejunal mucosa and swelling.
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Repeat esophagogastroduodenoscopy with push enteroscopy showed Grade D esophagitis, gastritis, and jejunal inflammation with edema and erythema (Figure 3).
(a). H&E (4X) of the jejunal biopsy with transitional area from normal (left side) to abnormal with diffuse infiltrate of the lamina propria with sheets of large neoplastic cells (b). Neoplastic cells with irregular nuclei, moderate clear cytoplasm, and a centroblastic morphology (40X) (c). CD20 homogeneously stains neoplastic B cells which are negative for CD10 (d) and positive for BCL6 (e). (f). Proliferation index is very high by Ki67.
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The proliferation index (Ki-67) was approximately 90% (Figure 4).