Adult Nodal Burkitt Lymphoma Forming Nodular Architectures

• Published in: Curēus (Palo Alto, CA) CA), 2021-10, Vol.13 (10)
• Main Authors: Tsutsumi, Yutaka, Yanagita, Soshi, Ohshima, Kouichi, Tachibana, Mitsuhiro
• Format: Article
• Language: English
• Subjects: Adults; Bone marrow; Case reports; Cellular biology; Chemotherapy; Cytoplasm; Dendritic cells; Epstein-Barr virus; Hematology; Hybridization; Immune system; Immunoglobulins; Lymphatic system; Lymphocytes; Lymphoma; Medical imaging; Pathology; Tomography
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.19130

In this report, we discuss a case of nodal Burkitt lymphoma seen in a 60-year-old Japanese male patient. Microscopic features of the biopsied 30 mm-sized cervical lymph node revealed nodular architectures with starry sky appearance surrounded by small mantle zone B-lymphocytes. Immunohistochemical and molecular studies demonstrated typical features of sporadic Burkitt lymphoma: the atypical cells were positive for CD20, CD79a, CD10, CD23, HLA-DR, bcl-6, PAX5, c-myc, and cytoplasmic IgM, but negative for CD3, CD5, CD15, CD30, CD34, TdT, bcl-2, and MUM1. The mantle zone B-cells were clearly positive for bcl-2 and IgD. In situhybridization (ISH) analysis for immunoglobulin light chains showed kappa-type monoclonality. A few nuclei were labeled for Epstein-Barr virus-encoded small nuclear RNA (EBER). Ki-67 labeling index was nearly 100%. Within the nodule, CD21, CD23, and CD35-positive follicular dendritic cells were scattered with a small number of CD3/CD5-positive small T-lymphocytes, indicating that the nodular architecture represented follicular colonization of Burkitt lymphoma cells. Karyotypic analysis revealed t(8;14)(q24;q32), and IGH-MYC fluorescence in situ hybridization (FISH) demonstrated IGH-MYC fusion signals. The presentation of follicular colonization was quite unique in Burkitt lymphoma in the present case. Differential diagnosis is also discussed.