ABSTRACT
A 2-year-old boy was diagnosed with ileocecal intussusception and
underwent surgical treatment and appendectomy. Appendix histopathology
revealed lymphoid cells with hyperchromatic nuclei, high mitotic
activity, and starry sky appearance. The patient was diagnosed with
Burkitt’s lymphoma, which involves many organs, such as the appendix,
liver, kidney, and bone marrow.
Keywords: Burkitt lymphoma, Intussusception, child.
A 2-year-old boy with no known past medical history presented to the
pediatric surgery department with abdominal pain, abdominal distention
and vomiting since three days ago. The patient was diagnosed with
ileocecal intussusception and underwent surgical treatment with
intussusception reduction and appendectomy.
In histopathological examination of appendix specimens, serosal layer
show an infiltrative neoplastic growth formed of sheets of small to
medium sized lymphoid cells with hyperchromatic nuclei, high mitotic
activity, and starry sky appearance (Figure 1A). The
immunohistochemistry (IHC) analysis of the samples revealed positive
Ki-67 expression in about 95% of tumoral cells (Figure 1B), negative
terminal deoxynucleotidyl transferase (TdT) expression (Figure 1C), and
diffuse positive CD20 expression in tumoral cells (Figure 1D).
For further evaluation, the patient underwent abdominopelvic computed
tomography (CT) scan and bone marrow biopsy and aspiration. As a result,
several hypodense hepatic lesions with a maximum diameter 7mm in the
hepatic segment II (Red arrow in Figure 2A) and hypodense lesion in
upper pole of left kidney (Blue arrow in Figure 2B) have been
discovered. The flow cytometry of bone marrow aspirate showed positivity
for CD10 (24%), CD19 (100%), CD20 (100%). Finally, the patient was
diagnosed with Burkitt’s lymphoma, which involve multi-organs, such as
appendix, liver, kidney, and bone marrow.
Burkitt’s lymphoma is a very aggressive B-cell lymphoma that is more
common in boys and has a peak incidence at age 6
years.1 According to world health organization (WHO)
classification, Burkitt’s lymphoma is divided into three classes based
on clinical features: endemic, sporadic, and
immunodeficiency-associated.1,2 The abdomen is the
most commonly involved location in sporadic burkitt’s
lymphoma.1 In Children, abdominal pain had various
causes, such as intussusception. 10% of patients with intussusception
have a pathologic cause, such as Burkitt’s lymphoma, despite the fact
that the majority of them are idiopathic.3 As a
conclusion, we should be aware of Burkitt’s lymphoma in childs with
intussusception and keep in mind that Burkitt’s lymphoma might have many
extra-nodal involvements.