A Rare Case of Burkittʼs Lymphoma of Stomach

Abstract

Purpose: To report of an unusual case of Burkitt's lymphoma which is very rare in non-endemic population who is HIV negative. Methods: Our patient is an 88-year-old white male with Alzheimer's disease who presented with melena and anemia with Hb of 6.7. Pt was orthostatic upon admission. There was history of loss of appetite, abdominal bloating, belching, non-bloody emesis. After volume resuscitation patient underwent an endoscopy. A large ulcerated mass was found in the antrum and biopsies were obtained. The cellular exam on pathologic examination revealed lymphoid infiltrate involving the glands deep. Immunostains with appropriate positive and negative controls showed CD 43+, CD 10+, CD 20+, Ki-67 positive in more than 90% of cells, H. pylori negative, AE1/AE3 negative. The final report was read as B-cell lymphoma with features of Burkitt's lymphoma and diffuse B cell lymphoma. Given patient's age and comorbidities, the family declined aggressive treatment and hospice was consulted over course of time. Results: Burkitt's lymphoma is a malignancy of B cell and is characterized by deregulation and translocation of the c-MYC gene on chromosome 8. Three main types are endemic, sporadic and immune deficiency associated. Endemic subtype occurs commonly in New Guinea and equatorial Africa and involves children. Sporadic Burkitt's lymphoma comprises less than 1 percent of all non-Hodgkins lymphoma and is seen in United States and western Europe. Estimated incidence is 3 cases per million person per year. Peak incidence is at age 11. Immune deficiency associated Burkitt's lymphoma is seen in HIV population and less commonly with other causes of immunodeficiency. Typical CD4 counts are more than 200 cells/microL. At this time there is incomplete understanding as to why and how B cells acquire genetic transformation that leads to overexpression of c-MYC and resultant expression of Burkitt's lymphoma. Curiously, chronic Epstein-Barr virus plays a role in almost all cases of endemic (African) Burkitt's lymphoma but only a minority of immunodeficient and sporadic Burkitt's lymphoma. Conclusion: Our case highlights a very rare cause of abdominal pain from Burkitt's lymphoma of stomach in advanced age group.Figure: No Caption available.