Colorectal Burkitt Lymphoma

Abstract

Purpose: Introduction: Patients with AIDS remain at increased risk for high-grade B cell lymphoma. The incidence of Burkitt lymphoma has dramatically increased since HIV appearance. However, in the era of HAART, only a few cases of colorectal Burkitt lymphoma have been reported these days. Burkitt lymphoma associated with AIDS is characterized by extensive lymphadenopathy and extranodal involvement. Case Presentation: A 32-yearold male with AIDS presented with rectal pain. The patient was noncompliant with HAART, and his last CD4 count was 156 cells per μl 2 months prior. He also admitted suprapubic abdominal pain associated with difficult urination. His vital signs were T 99.1F, HR 110/min, BP 149/85 mmHg, SpO2 98% on room air. Fullness with tenderness was observed in the suprapubic area. Rectal exam revealed a circumferential polypoid mass above the anal junction. Labs were significant for WBC 3800/μl, HGB 10.8 g/dL, PLT 103 K/μl and LDH 1901 U/L. The abdominal CT demonstrated multiple large soft tissue masses throughout the abdomen arising from the small bowel with the largest measuring 8.7 x 15 cm. Right hydronephrosis was also found. CTguided biopsy revealed high-grade B cell lymphoma with Burkitt's feature. Immunohistochemistry was positive for CD45, CD20, CD10, BCL-2, BCL-6, and negative for CD3, CD5, CD23, Cyclin D1. Proliferation index was more than 90%. Colonoscopy showed single large circumferential friable mass in the rectum. The patient was treated with chemotherapy consisting of etoposid, predonisone, vincristine, cyclophosphamide, and doxorubicin (EPOCH) with good clinical response. His rectal/abdominal pain and urinary symptoms improved. Discussion: A majority of AIDS-related lymphomas are high-grade B-cell tumors. Advanced stage at presentation is more frequent in the setting of HIV infection. However, with recent advances in HAART, colorectal involvement with the most aggressive type of B-cell lymphoma, Burkitt lymphoma, is not common. In our case, the patient was noncompliant with HAART and presented with extensive abdominal lymphadenopahy. Generalized lymphadenopathy is one of the main symptoms for Burkitt lymphoma associated with AIDS. Those patients can be presented with bowel obstruction, gastrointestinal bleeding or obstructive uropathy. Therefore, rectal pain or voiding symptoms in HIV patients should raise a suspicion for colorectal involvement of Burkitt lymphoma. In addition, unusual presentation of Burkitt lymphoma warrants an aggressive search for coexisting HIV infection.