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Case 35 

Case 35
Chapter:
Case 35
Author(s):

Ellen Chung

DOI:
10.1093/med/9780199758968.003.0035
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History

  • 5-year-old with abdominal pain.

Diagnosis

Case 35 Burkitt Lymphoma Involving Ileum and Kidneys

Findings

  • CT image (left) shows circumferential bowel wall thickening with focal mass-like areas (arrows).

  • More cephalad CT image demonstrates multiple, bilateral, hypoattenuating renal masses (arrowheads) and a mass in the spinal canal (curved arrow).

Differential diagnosis

The finding of bowel wall thickening has a broad differential, including infectious, inflammatory, neoplastic, and vascular causes. The presence of focal mass-like areas of thickening, the absence of inflammatory changes in the surrounding fat, and the presence of renal and other masses suggest Burkitt lymphoma.

Teaching points

  • Burkitt lymphoma, a type of non-Hodgkin lymphoma, is the most common abdominal lymphoma in children and the fastest-growing pediatric tumor, with a doubling time of 24 hours.

  • The World Health Organization recognizes three types.

    • Endemic—found in equatorial Africa and Papua New Guinea, has a high association with Epstein-Barr virus infection, and often involves the head and neck

    • Sporadic (American)—found in North America and Europe and commonly involves abdominal organs

    • Immunodeficiency related—occurs in children with HIV/AIDS, allografts, or congenital immune disorders

  • Burkitt lymphoma commonly involves the GI tract, especially the ileocecal region, and may cause diffuse mural thickening or focal masses. The latter are common lead points for intussusceptions in children over the age of 4 years. Cavitary lesions that communicate with the bowel lumen infrequently occur.

  • Retroperitoneum and mesentery are potential sites of adenopathy. Solid organs are common sites of disease, including the kidneys, liver, spleen, pancreas, ovaries, and breasts.

Next steps in management

Imaging for staging commonly includes CT, PET/CT, bone scintigraphy, and gallium scanning. PET/CT provides more anatomic information than gallium scanning and is likely more sensitive. With the increased concern about cumulative radiation dose, MR is likely to become more important in diagnosis and follow-up. The treatment is chemotherapy.

Further reading

1. Abramson SJ, Price AP. Imaging of pediatric lymphomas. Radiol Clin North Am. 2008 Mar;46(2):313–338, ix.Find this resource:

2. Jadvar H, Connolly LP, Fahey FH, Shulkin BL. PET and PET/CT in pediatric oncology. Semin Nucl Med. 2007 Sep;37(5):316–331.Find this resource: