Localized duodenal lymphoma masquerading as a duodenal ulcer

Area of Science:

• Gastroenterology
• Oncology
• Surgical Pathology

Background:

• Peptic ulcer disease is a common cause of abdominal pain and gastrointestinal bleeding.
• Atypical presentations of peptic ulcers can complicate diagnosis and treatment.
• Localized duodenal lymphoma is a rare but critical differential diagnosis.

Observation:

• A 64-year-old woman presented with symptoms including abdominal pain, weight loss, melena, and hematemesis.
• Initial diagnosis was a reactivated peptic ulcer, treated with antacids and cimetidine.
• Symptom recurrence led to the identification of a perforated duodenal ulcer on roentgenograms.

Findings:

• Laparotomy revealed the perforated duodenal ulcer to be a localized lymphoma of the duodenum.
• This case underscores the importance of considering lymphoma in atypical ulcer presentations.
• Endoscopic examination and biopsy are crucial for ruling out occult duodenal lymphoma.

Implications:

• Clinicians should maintain a high index of suspicion for duodenal lymphoma in patients with refractory or atypical peptic ulcer symptoms.
• Early diagnosis of duodenal lymphoma through biopsy can significantly alter patient management and prognosis.
• This case highlights the necessity of a thorough diagnostic workup beyond standard peptic ulcer treatment protocols.