Isolated Gastric Fundal Varices Caused by Diffuse Large B-Cell Lymphoma

A 59-year-old man with diffuse large B-cell lymphoma, recently diagnosed from a renal biopsy, presented to the emergency department with melena, dizziness, and epigastric pain. He was tachycardic and had a hemoglobin level of 6.4 g/dL. Esophagogastroduodenoscopy revealed isolated gastric fundal varices with stigmata and no esophageal varices. Abdominal ultrasound with Doppler showed a normal-appearing liver, patent splenic vein and hepatic vasculature, and no splenic vein thrombosis. He was managed supportively and discharged. A positron emission tomography-computed tomography scan for staging later revealed extensive neoplastic involvement of the pancreas, gastrohepatic ligament, celiac trunk, and perigastric and splenic hilar regions.