PRIMARY VITREORETINAL LYMPHOMA RECURRENCE AS A CAUSE OF UPPER GASTROINTESTINAL BLEEDING

In 2016, an immunocompetent 66-year-old man was diagnosed with diffuse large B cell vitreoretinal lymphoma. In his initial staging, no systemic involvement was found. He received both systemic chemotherapy and intraocular methotrexate with disease control. During follow-up no recurrence was reported. In October 2017, the patient was admitted to ER because of an episode of hematemesis without any other gastrointestinal symptoms. Upper endoscopy revealed an isolated ulcerated lesion, with an exophytic appearance and elevated edges in distal esophagus. In stomach, multiple ulcerated lesions with elevated edges and clean base were found in fundus and body. One of the ulcers had a non-bleeding visible vessel. In order to treat this lesion, haemostasis with double therapy (adrenaline injection and thermal coagulation with bipolar probe) was successfully performed. Tissue sampling of gastric and esophageal ulcers was performed during the procedure. Biopsies with Sydney protocol were also taken. Histopathological diagnosis was diffuse large B cell lymphoma infiltration. A CT revealed multiple retroperitoneal adenopathies and mesenteric implants. A new chemotherapy cycle was started.