Management of Hepatic Burkitt Lymphoma in Children

Abstract

Hepatic Burkitt lymphoma is extremely rare in childhood and can be overlooked in differential diagnosis of liver masses. Patient: A8-year-old girl presented with a 1 month history of abdominal pain and weight loss and jaundice. Results: Physical examination revealed hepatomegaly and no palpable lymph node. Laboratory finding showed mild anemia (hemoglobin, 10,8 g/dL), elevated transaminase (ALT, 305 IU/L; ASAT,755 IU/L), elevated bilitubin (Bilirubin total, 179mg/L, Bilirubin direct, 143mg/l). Abdominal ultrasound shouwed a multiple hepatic lesions. Liver biopsy examination confirmed Burkitt's lymphoma. No metastasis was detected in the thoracic cavity, bone marrow, and spinal fluid. The patient was treated with the combination regimen of cyclophosphamide, doxorubicin, vincristine, prednisone and high dose methotrexate. Cytosine arabinoside and methotrexate were added for CNS prophylaxis by intrathecal installation. Serial follow-up ultrasound showed a marked decrease in the size of hepatic lesions but residual hilar lymph nodes at 2cm and the control showed stable size of lymph node after 28 months of chemotherapy. Conclusion: The clinical feature of primary hepaticlymphoma varies from no symptom to fulminant hepatic failure. There are no specific imaging criteria for diagnosing primary hepatic Burkitt’s lymphoma. Thus, histology by biopsy is necessary for diagnosis.