Abstract
A Taiwanese woman in her fifties presented with a feculent odor and eructation. Her white cell count was 15.56 × 103/μL, albumin 3.2 g/dL, lactate dehydrogenase 335 U/L, C-reactive protein 4.8 mg/dL, and soluble interleukin-2 receptor 1,398 U/mL (reference range, 145 to 519 U/mL). Computed tomography (CT) revealed a left upper quadrant tumor encompassing the greater curvature of the stomach and splenic flexure of the colon to create gastrocolic fistula, and CT colonography confirmed communication between the two luminal organs. Upper gastrointestinal endoscopy showed a submucosal tumor at the greater curvature of the stomach and the orifice of the fistula was detected at the top of the tumor. Biopsies revealed the non-germinal center B-cell–like type of diffuse large B-cell lymphoma and lymphoma cells carried the BCL6 rearrangement. She was treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy under total parenteral nutrition and achieved a complete response after 6 cycles of R-CHOP; no perforation or bleeding complications occurred during the course of treatment. To the bestof our knowledge, this is the first report of DLBCL presenting with gastrocolic fistula that was successfully treated with R-CHOP chemotherapy, avoiding surgical intervention.
