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PEDIATRIC GASTRIC BURKITT’S LYMPHOMA WITH HELICOBACTER PYLORI INFECTION: CASE REPORT AND REVIEW OF THE LITERATURE
A Sarkhy, CC Barker
Department of Pediatrics, division of Pediatric Gastroenterology, BC Children’s Hospital, Vancouver, BC
STUDY AIM: To present a case of Gastric Burkitt’s Lymphoma, its response to therapy, and review the literature regarding this rare pediatric tumour and any association with H. pylori.
METHODS: We report a case of Burkitt’s lymphoma (BL) in a 15 year old Aboriginal boy who presented with iron deficiency anemia (Hemoglobin of 40 g/L with MCV of 62 fl), melena and intermittent abdominal pain. There was no history of vomiting, hematemesis or fever.
RESULTS: Upper endoscopy revealed a large ulcerated gastric mass with necrotic slough which extended from the gastric cardia to the incisura. Antral nodularity was also noted during the endoscopy. CT scan study revealed a large gastric mass involving the gastric wall & extending down from GE junction along both curvatures with sparing of the pylorus and antral region. The gastric biopsy found evidence of Burkitt’s lymphoma (BL). The typical BL translocation t (8; 14) was identified. H. pylori organisms were identified in the biopsy from the gastric antrum. The patient underwent a chemotherapy course as the mainstay therapy for BL which included prednisone, vincristine, cyclophosphamide, doxorubicin and intrathecal methotrexate with hydrocortisone. Also, he was treated with H. pylori eradication therapy which included the combination of oral ampicillin, metronidazole and omeprazole for two weeks. Within one month of starting chemotherapy, the patient had a repeated upper endoscopy which showed only a small gastric mass seen 2 cm below gastroesophageal junction. Gastric body and antrum were normal. However, the antral nodularity was still seen. Repeat CT scan revealed a significant regression in the gastric mass. There were no significant complications during his chemotherapy course and he tolerated well oral nutrition throughout the chemotherapy course.
CONCLUSIONS: To our knowledge, this patient is the first case reported with both pre and post-chemotherapy changes documented endoscopically. Literature of the association between Burkitt’s Lymphoma and H. pylori were reviewed. The association between H. pylori and MALT-Lymphoma is well documented but this is not the case for H. pylori and Burkitt’s Lymphoma. Finding the typical Burkitt’s Lymphoma translocation in our patient, makes the role of H. pylori as a trigger cause for developing the tumor as less likely. The limited available data in the literature can not be used to support the association between them.