Gastric plasmablastic lymphoma in HIV-negative patient

An 82-year-old female patient presented with melena, epigastric pain, progressive abdomen fullness and weight loss (8 kg) in the past 2 months. During physical examination, cutaneous pallor was evident and a large abdominal mass in epigastrium was palpable. There was no peripheric lymphadenopathy or hepatosplenomegaly. Blood count showed microcytic anemia and ferropenia (Hb = 7.5 g/dl, VGM = 79 fL; ferritin = 21 g/l, iron saturation = 23 %). Differential leukocyte counts, hepatic transaminase and lactate dehydrogenate levels were within normal limits. Upper gastrointestinal endoscopy revealed large gastric body ulceration with areas of mucosal hyperemia and pallor (Fig. 1). Computed tomography of the abdomen (Fig. 2) showed diffuse wall thickening involving the gastric fundus, body and antrum. Histological examination of the biopsy specimens revealed a diffuse, monomorphous proliferation of the tumour cells with features of immunoblasts, CD138, MUM-1, and kappa light chains positive (Fig. 3). These plasmablast-like features of tumour cells and lack of CD45 and B-cell associated antigens, disclosed the diagnosis of plasmablastic lymphoma (PBL). Serology was negative for the human immunodeficiency virus (HIV), the electrophoretic pattern of serum proteins was normal and the bone marrow biopsy was free of lymphoma at histological evaluation. The patient started treatment with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy, but died before the second cycle was given.