Gastrointestinal: Burkitt's lymphoma

Abstract

Lymphomas are solid malignancies of lymphoid tissue that can be categorized as either Hodgkin’s disease or nonHodgkin’s lymphoma. It is rare for Hodgkin’s disease to involve the gastrointestinal tract. Although the majority of non-Hodgkin’s lymphomas are thought to arise from lymph nodes, at least 30% arise in other organs and are called extranodal or primary lymphomas. Of these extranodal lymphomas, up to 40% are located in the gastrointestinal tract, particularly in the stomach and small bowel. Most of these lymphomas are of B-cell lineage. The most common are the diffuse large cell lymphoma and the marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma). Other B-cell lymphomas include Burkitt’s lymphoma, mantle cell lymphoma and follicular lymphoma. The images shown below were from a 76-year-old man who was admitted to hospital with malaise, weight loss and pain in the left flank. He subsequently had two significant episodes of hematemesis and melena. Upper gastrointestinal endoscopy revealed bleeding from multiple doughnut-like tumors in the body and antrum of the stomach (Fig. 1). He also had giant gastric folds. A computed tomography scan of the abdomen showed thickening of the wall of the jejunum and tumor infiltration of the left renal pelvis and parts of the right kidney. Histopathological examination of gastric biopsy specimens showed sheets of intermediate-sized lymphoid cells crowding between glands with an interspersed starry-sky pattern (Fig. 2; HE: ×200). Immunohistochemical stains were positive for CD20 (indicating B-cell lineage) and almost all cells were positive for Ki-67 (indicating an extremely high proliferation rate). The diagnosis was that of Burkitt’s lymphoma. Apart from Burkitt’s lymphoma, multiple gastric polypoid lesions with central ulceration can be seen in Kaposi’s sarcoma, stromal cell tumors, metastatic gastric tumors and other lymphomas. Although only 1‐2% of adult non-Hodgkin’s lymphoma are of the Burkitt’s variety, substantially higher percentages have been described in the pediatric setting and in patients with HIV. Blackwell Science, LtdOxford, UKJGHJournal of Gastroenterology and Hepatology0815-93192005 Blackwell Publishing Asia Pty LtdOctober 2005201016161616Images of Interest Images of InterestImages of Interest