Infantile non-African Burkitt's lymphoma presenting as bilateral fulminant exophthalmos

Profile of Childhood Non-Hodgkin Lymphomas at a Tertiary Care Hospital

Context: Lymphoma was the second most common malignancy accounted for 22% of pediatric cases, of which 34 (68%) were non-Hodgkin’s lymphoma (NHL). Aims: To find the incidence, clinical presentations, laboratory findings, proportion of extranodal involvement, and to study histological subtypes (REAL/WHO classification) of NHL, compare them with reported case series in the world literature. Settings and Design: Gross specimens and biopsies of pediatric NHL were retrieved from the Department of Surgical Pathology from the year 2004 to 2013 at a tertiary care hospital. Patients and Methods: Gross and microscopy of incisional biopsies and surgically resected specimens of pediatric cases were studied using hematoxylin and eosin stain and wherever needed special stain and immunohistochemistry were used. Results: The incidence of NHL was higher in more than 10 years of age group with male predominance. Burkitt’s lymphoma (BL) (41.2%) was the most common subtype followed by T-lymphoblastic lymphoma (T-LL) (29.4%). Predominantly extranodal presentation was seen, BL presented as ileocecal masses (five cases) and orbital swelling (three cases). T-LL presented as a mediastinal masses (six cases). Rare cases of precursor B-LL involving orbital mass and plasmablastic lymphoma involving paranasal sinuses were studied. Among bone marrows studied a case of T-LL developed pancytopenia, during chemotherapy showed giant pronormoblast (Parvovirus infection). HIV association was seen in five cases of NHL. Postchemotherapy disease-free survival was very low and many patients died during chemotherapy. Conclusion: Although the incidence of HL is higher in children, in the present study, NHL with extranodal presentation (58%) involving rare sites with poor prognosis is higher, 15% of all cases showed HIV seropositivity.

Orbital involvement in nonendemic Burkitts lymphoma

Burkitt's lymphoma (BL) is a rare monoclonal proliferation of Blymphocytes and is classified as a poorly differentiated lymphocytic lymphoma. Typically, Burkitt's lymphoma involves the jaw bones, but the orbit can also be involved. Burkitt"s lymphoma is seen, sporadically in India, and 3 cases of orbital Burkitt's lymphoma were diagnosed during the past 4 years. Three cases of acute proptosis in children are presented to us. The provisional clinical diagnosis was rhabdomyosarcoma and the histopathology revealed Burkitt's lymphoma. The fast growth rate, hematologic manifestations and the urgency of diagnosis are emphasized. We present 3 cases here and review prevailing concepts about Burkitt's lymphoma.

Orbital burkitt lymphoma in immunocompetent patients: a report of 3 cases and a review of the literature

PURPOSE

To describe a series of 3 immunocompetent patients with the sporadic form of orbital Burkitt lymphoma and review the outcomes of such patients reported in the scientific literature.

METHODS

Retrospective review of medical records and the literature. Cases of orbital Burkitt lymphoma in immunocompromised and African patients were excluded from the review. Measured parameters included gender, age, ocular signs, imaging results, the range of systemic involvement, and treatment.

RESULTS

Current cases and review of the scientific literature resulted in 16 immunocompetent patients with sporadic orbital Burkitt lymphoma. The median age at presentation was 12 years. Most common ocular signs at presentation were proptosis (13/16), external ophthalmoplegia (9/16), and eyelid edema (7/16). Optic neuropathy was noted in 5 of 16 patients. Concomitant paranasal sinus involvement was present in 8 of 16 patients. Fourteen (88%) of the patients had systemic involvement, of which the most common locations were central nervous system (6/16), lymphatics (6/16), bone marrow (6/16), and liver (4/16). Survival data were available for 13 patients. Seven patients (54%) died within 12 months of presentation.

CONCLUSIONS

Sporadic orbital Burkitt lymphoma occurs in immunocompetent individuals with a wide age range. Fifty percent presented with adjacent paranasal sinus involvement. Concurrent or eventual systemic involvement is common. The large number of patients with central nervous system involvement in our review of the literature supports the role of lumbar puncture and neuroimaging in the workup of all patients with orbital Burkitt lymphoma. Prognosis remains guarded, with significant mortality within 1 year of presentation.

Burkitt's lymphoma

Cancer is the second leading cause of death in children and, among cancers, lymphoma is the third most frequently diagnosed type. The majority of these are non-Hodgkin's lymphomas (NHL). Although NHL have been grouped in a variety of confusing ways, recent research in cytogenetics and immunology, coupled with a better understanding of the normal pathways of lymphoid differentiation, has greatly lessened this confusion. Burkitt's lymphoma (BL) is a type of B-cell NHL which is sub-classified as either endemic (African) or non-endemic (American). Kinetic studies have demonstrated a doubling time of only 24 h. As a result of this extremely rapid growth, symptomatic complaints occur early in the disease course. Structures contiguous to the primary become compressed and metabolic derangements occur. Signs of chronic debilitation such as cachexia, diarrhea, generalized lymphadenopathy, and weight loss usually are not found. Thirteen cases of American BL have been treated since 1980 at the Texas Children's Hospital and form the basis of this review. Ten patients had obstructive abdominal symptoms including constipation and pain, and 3 had masses in the neck, maxilla, or tonsil. Systemic manifestations included ascites, jaundice, fever, and hepatosplenomegaly. Two patients ultimately developed central facial nerve paralysis.