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Leukemic conversion in case of Burkitt’s lymphoma from non-endemic region

Chandra H

Department of Pathology, Himalayan Institute of Medical Sciences, SRHU,Swami Ram Nagar, Doiwala, Dehradun, Uttarakhand, India

E-mail : aa

Chandra S

Department of Pathology, Himalayan Institute of Medical Sciences, SRHU,Swami Ram Nagar, Doiwala, Dehradun, Uttarakhand, India

Gupta V

Department of Pathology, Himalayan Institute of Medical Sciences, SRHU,Swami Ram Nagar, Doiwala, Dehradun, Uttarakhand, India

Shrivastav V

Department of Pathology, Himalayan Institute of Medical Sciences, SRHU,Swami Ram Nagar, Doiwala, Dehradun, Uttarakhand, India

DOI:10.15761/BHC.1000141

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Abstract

Burkitt’s lymphoma is rare neoplasm which may be either be endemic involving mandible and maxilla or sporadic presenting with abdominal lump. The leukemic conversion of Burkitt’s lymphoma without any tumour mass is considered to be unusual and that too in immunocompetent patient. The present case is therefore being reported due to its unusual presentation with absence of any abdominal or facial mass but with only bone marrow involvement in non-endemic region. The case also highlights an important feature of leukemic conversion of Burkitt’s lymphoma in immunocompetent patient which is rarely reported in literature.

Key words

Burkitt’s lymphoma, leukemia, non-endemic

Introduction

Burkitt’s lymphoma is rare neoplasm which may be either be endemic involving mandible and maxilla and associated with Epstein Barr virus or sporadic which is associated with EBV in only 10-20% of cases [1,2]. The leukemic conversion of Burkitt’s lymphoma without any tumour mass is considered to be unusual and that too in immunocompetent patient [3,4]. The present case is therefore being reported due to its unusual presentation with absence of any abdominal or facial mass but with only bone marrow involvement in non-endemic region. The case also highlights an important feature of leukemic conversion of Burkitt’s lymphoma in immunocompetent patient which is rarely reported in literature.

Case report

Twelve-year female presented with fever and her investigations revealed pancytopenia with hemoglobin 46 gm/L, total leukocyte counts 3.67x109/L and platelet count 16.2x109/L. Her differential count showed 30% large lymphoid cells with moderate cytoplasm, coarse chromatin and showing cytoplasmic and nuclear vacuolations (Figure 1). Her bone marrow aspirate and biopsy revealed complete effacement of marrow with blasts of same morphology (Figure 2 a,b). Peripheral blood on flowcytometry showed positivity for CD45 (bright), CD19, CD10, CD43and negativity for CD3, CD5, CD20, BCL-2, CD25 and kappa/lambda. Immunohistochemistry on bone marrow biopsy showed positivity of Ki-67 in more than 95% blasts (Figure 3). She was non- reactive for human immunodeficiency virus. In view of above findings, diagnosis of Burkitt’s lymphoma with leukemic conversion was considered. However, no cytogenetic and molecular analysis was done due to patient’s reluctance and financial constraints. The condition of patient deteriorated rapidly, and patient succumbed to her illness within a week.

Figure 1. Moderate cytoplasm, coarse chromatin and showing cytoplasmic and nuclear vacuolations.

Figure 2. Bone marrow aspirate and biopsy revealed complete effacement of marrow with blasts of same morphology.

Figure 3. Immunohistochemistry on bone marrow biopsy showed positivity of Ki-67 in more than 95% blasts.

Discussion

Burkitt’s lymphoma is considered to be an aggressive neoplasm with high proliferative index and may lead to death if not treated early [5]. Although EBV is associated with endemic cases but AIDS related malignancies constitute 2.4-20% of Burkitt’s lymphoma [6]. The tumour is endemic in African countries with involvement of mandible and maxilla while sporadic cases present with abdominal lump [7,8]. The Burkitt’s lymphoma may rarely have leukemic presentation but these cases are usually associated with large tumour mass.3 However this case presented with leukemic conversion in Burkitt’s lymphoma with absence of any abdominal or facial mass but with only bone marrow involvement. Epeldegui et al have observed in their study that high expression of activation induced cytidine deaminase (AID) in peripheral blood mononuclear cells has been shown to precede the development of BL by up to 8 years in HIV-infected patients [9]. However, our patient was immunocompetent. The prognosis of Burkitt's cell leukemia has not been reported with current treatment modalities and it has been concluded that there is no further need for stem cell transplantation in Burkitt’s cell leukemia [10]. The condition of the patient in our case deteriorated rapidly and patient succumbed to her illness within a week.

The present case thus highlights unusual presentation of Burkitt’s lymphoma with absence of any abdominal or facial mass but with only bone marrow involvement in non-endemic region. The case also highlights an important feature of leukemic conversion of Burkitt’s lymphoma in immunocompetent patient and with poor prognosis.

Financial support

None

Conflicts of Interest

None

References

  1. Konjeti VR, Hefferman GM, Paluri S, Ganjoo P (2018) Primary Pancreatic Burkitt's Lymphoma: A Case Report and Review of the Literature.Case Rep Gastrointest Med2018: 5952315. [Crossref]
  2. Jacobson C, LaCasce A (2014) How I treat Burkitt lymphoma in adults.Blood124: 2913-2920. [Crossref]
  3. Song JY, Venkataraman G, Fedoriw Y, Herrera AF, Siddiqi T, Alikhan MB, Kim YS, Murata-Collins J, Weisenburger DD, Liu X, Duffield AS (2016) Burkitt leukemia limited to the bone marrow has a better prognosis than Burkitt lymphoma with bone marrow involvement in adults. Leuk Lymphoma 8: 1-6. [Crossref]
  4. Foucar K (2001) Acute lymphoblastic leukemia. In: Foucar K, ed. Bone marrow pathology. 2nd Ed. Chicago, Ill: ASCP Press, 2001: 481-514.
  5. Evens AM, Gordon LI (2002) Burkitt's and Burkitt-like lymphoma.Curr Treat Options Oncol3: 291-305. [Crossref]
  6. Basavaraj A, Shinde A, Kulkarni R, Kadam DB, Chugh A (2014) HIV associated Burkitt's lymphoma.J Assoc Physicians India62: 723-727. [Crossref]
  7. Ugar DA, Bozkaya S, Karaca I, Tokman B, Pinarli FG (2006) Childhood craniofacial Burkitt’s lymphoma presenting as maxillary swelling: report of a case and review of literature. J Dent Child (Chic) 73: 45-50. [Crossref]
  8. Regezi JA, Scuibba JJ, Jordan RC, (2003) Oral pathology. Clinical pathological correlations. Elsevier Science: Missouri pp.331-333.
  9. Epeldegui M, Breen EC, Hung YP, Boscardin WJ, Detels R, et al. (2007) Elevated expression of activation induced cytidine deaminase in peripheral blood mononuclear cells precedes AIDS-NHL diagnosis.AIDS21: 2265-2270. [Crossref]
  10. Malkan ÜY, Güneş G, Göker H, Haznedaroğlu İC, Acar K, et al. (2016) The prognosis of adult Burkitt’s cell leukemia in real life clinical practice. Turk J Haematol 33: 281-285. [Crossref]

Editorial Information

Editor-in-Chief

Osmar A. Centurion
Asuncion National University

Article Type

Case Report

Publication history

Received date: July 20, 2018
Accepted date: July 30, 2018
Published date: August 02, 2018

Copyright

©2018 Chandra H. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Citation

Chandra H, Chandra S, Gupta V, Shrivastav V (2018) Leukemic conversion in case of Burkitt’s lymphoma from non-endemic region. Blood Heart Circ 2: DOI: 10.15761/BHC.1000141

Corresponding author

Chandra S

Department of Pathology, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Doiwala, Dehradun, Uttarakhand, India, Tel: +91 9411718455

Figure 1. Moderate cytoplasm, coarse chromatin and showing cytoplasmic and nuclear vacuolations.

Figure 2. Bone marrow aspirate and biopsy revealed complete effacement of marrow with blasts of same morphology.

Figure 3. Immunohistochemistry on bone marrow biopsy showed positivity of Ki-67 in more than 95% blasts.