Precursor B lymphoblastic lymphoma is a high-grade neoplasm arising from precursor lymphocytes of B-cell lineage. Extranodal sites such as the skin and bone are often involved, but gastrointestinal lesions of this disease are rarely encountered. Due to the infrequency, macroscopic forms of the gastrointestinal lesions have not been fully described. In this report, we present a case of precursor B lymphoblastic lymphoma involving the stomach, pancreas, bone, and bone marrow. Esophagogastroduodenoscopy showed multiple flat elevated lesions with irregular mucosa in the stomach. 1. Introduction Precursor B lymphoblastic lymphoma is a neoplasm of lymphoblasts committed to the B-cell lineage [1]. Histologically, neoplastic cells are composed of small- to medium-sized lymphoid cells with blastic nuclear chromatin and a high mitotic rate [2]. In immunohistochemical analysis, the disease is characterized by positive staining for terminal deoxynucleotidyl transferase (TdT), in addition to B-cell antigens [1]. Clinically, extranodal sites such as the skin and the bone are frequently affected. On the other hand, infiltration of the neoplastic cells into the gastrointestinal tract is relatively infrequent. Therefore, the endoscopic manifestation of this disease has not been fully revealed to date. We recently treated a patient with precursor B lymphoblastic lymphoma who had extensive extranodal involvement in the stomach, pancreas, bone, and bone marrow. Herein we report the case and illustrate its characteristic endoscopic features. 2. Case Presentation An 85-year-old Japanese female presented to Onomichi Municipal Hospital with facial pain and lockjaw due to a swelling of the left temporomandibular joint. Her pain had started one year previously. The patient went to another clinic at that time, but the cause of her symptoms was not revealed. Two months prior to her visit to our hospital, she went to a dental clinic because lockjaw had appeared. Subsequently, swelling of the temporomandibular joint worsened and she was referred to our hospital for further investigation and treatment. She had been taking antihypertensive agents for hypertension and antifungal agent for nail tinea of the feet. The patient had no previous history of hematopoietic or gastrointestinal diseases. Physical examination revealed no abnormalities except for a mass lesion in the left temporomandibular joint. There was no evidence of hepatosplenomegaly or peripheral lymphadenopathy. Laboratory findings revealed elevated levels of lactate dehydrogenase (LDH) to 232？IU/L (normal range:
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