Non hodgkin lymphoma presenting as acute abdomen: perforation peritonitis : a rare case report and literature review

Primary gastric lymphoma with spontaneous perforation is rare. Case presentation: We present a case involving a 62-year-old woman who was admitted to the emergency department due to widespread abdominal discomfort, ongoing vomiting, and constipation.. Based on investigations, a diagnosis of peritonitis due to a viscous perforation was made. Patient was operated on and intraoperatively around 1x1 cm perforation surrounded by induration of around 3x3 cm (resembling punched out ulcer) was found on the anterior surface of the body of stomach 7 cm from the pyloric sphincter. Wide local excision of the perforation with its surrounding indurated area was done followed by primary repair of the stomach defect. A Witzel's feeding jejunostomy was created omental and D10 LN biopsy was done. On histopathology of specimens , the gastric wall showed diffuse infiltration involving its full thickness; a group of sizable, unusual lymphoid cells was observed. At the location of the perforation, tumor cells accompanied by necrotic material were detected in conjunction with the base of the ulcer, findings consistent with non-Hodgkin's lymphoma. Immunohistochemical staining were positive for CD20,LCA ,BCL6&2 and negative for Cd3, Cd 10,Cd23, the Ki67 index was- 60_70%. Conclusion: A case report detailing a spontaneous perforation resulting from primary gastric malignant lymphoma has been presented, along with a review of pertinent literature. This case underscores the need for further studies to better understand the association between surgical indications and pathological findings in such scenarios. Additionally, more research is essential to evaluate the clinical implications and management strategies for spontaneous perforation in primary gastric lymphoma.