Due to the rarity of duodenal lymphoma, there is a lack of information on the appropriate treatment plans. The duodenum is a challenging area for surgery, so complete removal of the lymphoma is uncommon. Aggressive chemotherapy is not recommended due to the risk of perforation. Therefore, a multidisciplinary strategy was developed, which involved using rituximab and less intensive chemotherapy followed by radiotherapy. This approach was considered safe and effective [2].
Sarkhosh and al analyzed the use of surgery in the treatment of duodenal lymphoma in their study [3]. They reviewed a total of 23 cases, of which eight (35%) were treated with surgery alone, eight (35%) with surgery along with chemotherapy, five (22%) with chemotherapy only, and two (9%) with supportive care. The patients who underwent surgery were mostly in emergency situations such as obstruction (58%), perforation (33%), and hemorrhage (8%). Prior to immunochemotherapy, gastrojejunostomy was performed. Approximately 50% of perforations in gastrointestinal lymphomas occur during the initial presentation, while the other 50% occur after chemotherapy [5].
Gastrointestinal lymphoma-related perforation can lead to sepsis and/or peritoneal dissemination of the disease, which results in a high mortality rate of approximately 60% and a poor outcome [6, 7].
The immunocompromised subtype of Burkitt lymphoma of the duodenum is exceptionally uncommon across all variants, and the current literature on this topic is very limited. Duodenal involvement in Burkitt lymphomas is believed to represent less than 1% of all cases due to the scarcity of cases available for study[8].
Usually; Burkitt lymphoma is common in patients with AIDS, when treating immunocompromised patients with chronic abdominal symptoms, especially those with complications such as bleeding or occult positive testing, there should be a high level of suspicion for lymphomas. Early intervention with endoscopy and biopsy can aid in the identification of these conditions, leading to improved outcomes for patients [9, 10].
when treating gastrointestinal lymphoma; Takagishi et al recommend a multidisciplinary approach with this regimen: first, rituximab alone, followed by less intensive chemotherapy without vincristine, when the patient's health improves and the mass size decreases, complete chemotherapy may be administered. If the lymphoma remains localized, consolidation radiotherapy is effective in eliminating any remaining mass [2].
Chemotherapy response rates are very high and effective for the disease, so treatment of lymphomas should largely be medical. Therefore, for these patients, surgical intervention should only be used for diagnosis or relieving emergency situations, such as obstruction, perforation, or bleeding. Extensive bowel resections should be avoided [11].