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Jaspreet S Grewal, Naresh T Gunaratnam, John C Krauss, Lauren B Smith
Am J Case Rep 2010; 11:16-19
Background: Burkitt lymphoma (BL) is a high grade, diffuse, small non-cleaved B-cell non-Hodgkin lymphoma (NHL). Endemic BL occurs in equatorial Africa and involves the jaw and facial bones in young children. Sporadic BL occurs in rest of the world and frequently presents as an abdominal mass. Sporadic BL rarely involves the head and neck region. BL involving the thyroid gland is rare and has never been reported with pancreatic and small intestinal involvement and associated pancreatitis.
Case Report: An unusual case of a 31-year-old male from India is reported who was diagnosed with Stage IV BL involving the thyroid gland, pancreas and the small intestines (jejunum and ileum). Morphologic evaluation of the open thyroid biopsy and endoscopic ultrasound guided (EUS) pancreatic needle aspirate was consistent with BL. The diagnosis was confirmed with immunohistochemistry (IHC), flow cytometry and fluorescence-in-situ-hybridization (FISH). The patient was successfully treated with CODOX-M/IVAC chemotherapy regimen in combination with rituximab and is in remission two years after the completion of the treatment.
Conclusions: Our patient presented with a very unusual clinical presentation of BL involving the thyroid gland and multiple abdominal organs. Morphologic evaluation of the tissue biopsy should be complemented with IHC, flow cytometry and FISH, and guided by 2008 World Health Organization (WHO) Classification of Tumors of Hematopoietic and Lymphoid Tissues to confirm the diagnosis. Complete remission in patients with BL presenting with multiple organ involvement can be achieved with aggressive chemotherapy.