Primary osseous Burkitt lymphoma with nodal and intracardiac metastases in a child

Urgent Excision of Primary Intracardiac Burkitt Lymphoma in a Child

A 9-year-old girl presented with a recent history of shortness of breath, fatigue, visual disturbances, and gastrointestinal symptoms. Echocardiography demonstrated three large intracardiac masses in the right and left atria protruding into the mitral and tricuspid valve orifices causing bilateral inflow obstruction. She underwent urgent surgical excision of the masses. Histology revealed rare intracardiac Burkitt's Lymphoma.

Acute left ventricular insufficiency in a Burkitt Lymphoma patient with myocardial involvement and extensive local tumor cell lysis: a case report

Background

Burkitt lymphoma (BL) is a rare disease with the sporadic variant accounting for less than 1% of adult non-Hodgkin lymphomas. BL usually presents with an abdominal bulk, but extranodal disease affecting the bone marrow and central nervous system is common. Cardiac manifestations, however, are exceedingly rare, with less than 30 cases reported in the literature.

Case presentation

We report on a 54-year-old male patient with a six week-long history of paranasal sinus swelling, fatigue and dyspnea on exertion. Stage IV sporadic BL with extensive lymphonodal and cardiovascular involvement was diagnosed. Manifestations included supra- and infradiaphragmatic lymphadenopathy as well as infiltration of the aortic root, the pericardium, the right atrium and the right ventricle. EBV-reactivation was detected, which is uncommon in the sporadic subtype. After initial full-dose chemotherapy with very good BL control, the patient developed acute, but fully reversible cardiac insufficiency. Myocardial lymphoma involvement receded completely during the following two therapy cycles, while cardiac function periodically deteriorated shortly after chemotherapy administration and quickly recovered thereafter. Interestingly, the decline in cardiac function lessened with decreasing myocardial lymphoma manifestation. Once the cardiovascular BL infiltration was resolved, cardiac function remained stable throughout further treatment. Following seven cycles of chemotherapy and mediastinal radiation, the patient is now in continued complete remission.

Conclusions

Although rare, cardiac involvement in BL can quickly become life-threatening due to rapid lymphoma doubling time and should therefore be considered at initial diagnosis. This case suggests an association between myocardial infiltration, chemotherapy associated tumor cell lysis and transient deterioration of cardiac function until the damage caused by the underlying lymphoma could be restored. While additional studies are needed to further elucidate the mechanisms of acute cardiac insufficiency due to lymphoma lysis in the infiltrated structures, prompt BL control and full recovery of the patient supports courageous treatment start despite extensive cardiovascular involvement.

Multifocal precursor B-cell lymphoblastic lymphoma in an infant with cardiac involvement: A case report

Lymphoma with cardiac involvement is a high-risk lesion, especially in children. We report a rare clinical case of multifocal precursor B-cell lymphoblastic lymphoma in a child with cardiac involvement. A 4-year-old boy presented to the Vietnam National Children's Hospital with a vague headache, but magnetic resonance imaging of the head was normal. After 1 week, the patient showed symptoms of chest pain, fatigue, dyspnea, and abdominal pain. On transthoracic echocardiography and multislice computed tomography of the thorax, a mass was detected in the right atrial wall. Abdominal ultrasound showed a small bowel intussusception, multiple nodules in the intestinal wall, and mesenteric lymph nodes. Histopathology of the bowel confirmed the diagnosis of multifocal precursor B-cell lymphoblastic lymphoma. The patient responded to 3 cycles of chemotherapy for lymphoma. Therefore, combining multiple imaging methods allowed for early diagnosis and improved treatment.

Primary ovarian Burkitt's lymphoma presentation in a young woman: A case report

INTRODUCTION AND IMPORTANCE

Burkitt's lymphoma is one of the fastest growing human cancers and it needs a rapid diagnosis.

CASE PRESENTATION

A young woman presented to our institution with acute abdominal pain, tenderness and constipation. Ultrasound reported a right ovarian mass; at laparoscopy, we discovered ascites, peritoneal carcinomatosis and a voluminous pelvic mass.

CLINICAL DISCUSSION

Diagnosis was confirmed as non-Hodgkin sporadic Burkitt's lymphoma: the careful workup was the key to initiate multiagent chemotherapy.

CONCLUSION

Primary ovarian Burkitt's lymphoma, in a young woman in a non-endemic zone, is a rarity that represents a strong diagnostic challenge, but rapid identification can lead the patient to appropriate therapies and improvement of prognosis.

Silent presentation of multiple metastasis Burkitt lymphoma in a child: A case report and review of the literature

RATIONALE

The Burkitt lymphoma (BL) is a very aggressive B-cell non-Hodgkin's lymphoma. It accounts for 34% of lymphoma cases in children.

PATIENT CONCERNS

We present the case of a 6-year-old boy diagnosed with BL, who presented multiple contrasting elements of the disease: silent symptomatology, without involvement of the bone marrow at first, but with multiorgan infiltration and a fast evolution, despite starting the treatment shortly after the symptoms appeared.

DIAGNOSES

He was diagnosed with BL after immunophenotyping from the pleural fluid.

INTERVENTIONS

After a week from admission, chemotherapy was initiated according to protocol NH-BFM therapeutic group III-cytoreductive phase in the acute care ward and subsequently the AA 24 treatment.

OUTCOMES

Following the treatment, the patient developed medullary aplasia and cutaneous toxicity. The patient's general state remained severe during the hospitalization.

LESSONS

Even though the prognosis of BL has improved over time (up to 90% survival rate), in this case the evolution was unfavorable. In our patient, the symptoms appeared abruptly. They appeared late in the phase of multiple-organ dissemination, which generated the pessimistic prognosis.