Imaging Findings:
In suspicion of oro-pharyngeal malignancy, the patient underwent CE MRI
of neck which showed a homogenously enhancing well circumscribed
lobulated T1 hypointensity and T2 hyper intensity lesion measuring 4.0 x
2.8 x 2.0cm involving the right side of the oropharynx and tonsil(Fig
1). The lesion was causing partial effacement of the right side of
vallecula, without midline extension of the lesion noted. No extension
of the lesion beyond the confinement of oropharynx seen. Diffusion
restriction noted with ADC value of 0.4 x
10^-3mm2/sec on b value of 800. Patient was
counselled about the possibility of malignant lesion and was advised for
biopsy to rule out malignancy. Punch biopsy was done and histopathology
followed by immunochemistry and Interphase fluorescence in situ
hybridization (FISH) confirmed it as case of Burkitt Lymphoma.
Microscopic Findings showed multiple fragments of tissue, partially
lined by non-keratinized stratified squamous epithelium. Sub epithelium
showed infiltration by monotonous population of atypical lymphoid cells.
Those atypical lymphoid cells were intermediate to large in size with
round to ovoid with coarse chromatin, irregular nuclear membrane, scant
cytoplasm. Cytoplasm was scant in amount. Immunohistochemistry showed
atypical lymphoid cells which were diffusely positive for CD45, CD20,
PAX-5, CD10, BCL6 (weak), MUM-1, c-MYC (45%), while they are negative
for CK (AE1/AE3), CD3, BCL2, Cyclin-D1, CD21 and CD34. Ki67
proliferation index is approximately 90%.
Thoracic abdominal and pelvic CT scans did not show any distant
extension of the disease. Bone marrow aspiration and biopsy showed
normocellular marrow. The complete blood count was unremarkable. Human
immunodeficiency virus (HIV) serology was negative. Serology testing was
positive for anti‑Epstein–Barr virus IgG.