Burkitt-type lymphoma incidentally found as the cause of acute appendicitis: a case report and review of literature

Preoperative prediction of malignancy and surgical treatment strategy in appendiceal tumors: multicenter review of 51 consecutive cases

PURPOSE

A diagnostic and treatment strategy for appendiceal tumors (ATs) has not been established. We aimed to evaluate our treatment strategy in ATs, including laparoscopic surgery (LS), and to identify preoperative malignancy predictors.

METHODS

A total of 51 patients between 2011 and 2021 were retrospectively reviewed. Data, including tumor markers and imaging findings, were compared between carcinoma and non-carcinoma patients. Validity of planned operation was evaluated based on pathological diagnosis.

RESULTS

Twenty-five patients were diagnosed with carcinoma, 13 with low-grade mucinous neoplasm, and 13 with other diseases. Symptoms were more commonly present in carcinoma patients than in non-carcinoma patients (68.0% vs. 23.1%, p = 0.001). Elevated CEA and CA19-9 were more frequently observed in carcinoma patients than in non-carcinoma patients (p < 0.01 and p = 0.04, respectively). Five carcinoma patients had malignancy on biopsy, compared with zero non-carcinoma patients. Significant differences were noted in the percentages of carcinoma and non-carcinoma patients with solid enhanced mass (41.7% vs. 0%, p < 0.001) and tumor wall irregularity (16.7% vs. 0%, p = 0.03) on imaging. Although the sensitivity was not high, the specificity and positive predictive value of these findings were 100%. Forty-two patients (82.4%) underwent LS as minimally invasive exploratory and/or radical operation, of whom 2 were converted to open surgery for invasion of adjacent organ. No patients had intraoperative complications or postoperative mortality.

CONCLUSION

Clinical symptoms, elevated tumor markers, and worrisome features of solid enhanced mass and tumor wall irregularity on imaging can be malignancy predictors. For management of ATs, LS is feasible and useful for diagnosis and treatment.

Burkitt Lymphoma of the Appendix Presenting With Acute Appendicitis and Acute Kidney Injury: A Case Report and Review of Literature

The gastrointestinal tract is one of the most common sites for extranodal Burkitt lymphomas (BLs), but an appendiceal BL is extremely rare. We describe a case of appendiceal BL presenting with acute appendicitis and acute kidney injury. A 15-year-old obese male presented to the emergency department with fever and right-sided abdominal pain. WBC count was slightly increased, and a CT scan of the abdomen showed features of ruptured appendicitis and peritonitis. The patient was placed on antibiotics, and an interval appendectomy was planned. The patient developed a worsening acute kidney injury one day later, requiring a laparoscopic appendectomy. Gross examination of the appendix revealed a dilated, firm, sausage-like appendix with a hemorrhagic serosa and a firm mesoappendix. Microscopic examination of the appendix showed a dense diffuse infiltration of monomorphic medium-sized atypical lymphoid cells with round nuclei, dispersed chromatin, and small nucleoli. Few scattered macrophages created a vague "starry sky" appearance. Many mitotic figures were seen. The lesion also involved the mesoappendix. Immunohistochemical analysis showed that the lymphoma expressed CD10, CD20, and BCL6 but was negative for CD34, BCL2, and TdT. Later, the fluorescence in situ hybridization (FISH) analysis detected an IGH-MYC (8;14) fusion. A final diagnosis of appendicular Burkitt lymphoma was made. Two weeks later, a bone marrow biopsy performed for staging showed involvement of bone marrow by BL. The patient lost follow-up after that due to the transfer of care to another hospital.

Double-Expressor Appendiceal Burkitt’s Lymphoma: A Case Report and Literature Review

Background

Appendiceal lymphoma is a very rare entity accounting for 0.015% of all gastrointestinal lymphoma cases. Acute appendicitis is the most common presentation of primary appendix neoplasms. Burkitt's lymphoma presenting as an acute appendicitis is a rare entity with around 21% of the cases presenting as a lower iliac fossa mass. Case Presentation. A 23-year-old male was admitted to the surgical ward as a case of acute appendicitis with localized tenderness in the right iliac fossa, positive rebound tenderness, a positive Rovsing's sign, and ultrasound findings of suspected complicated appendicitis. Appendectomy was performed. Histopathological examination of the appendectomy specimen revealed a double-expressor non-Hodgkin diffuse large cell lymphoma with Burkitt's-like morphology. He was sent for chemotherapy treatment.

Conclusion

Only 34 cases of Burkitt's lymphoma have been reported to present as acute appendicitis. Histological examination following appendectomy for an apparent appendicitis is essential. Furthermore, complete blood count and a computed tomography scan aid the diagnosis of lymphoma. Double-expressor lymphoma has been shown to have poor outcomes. Therefore, prompt and aggressive treatment is vital.