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13 February 2020 : Case report  Australia

Burkitt Leukemia Presenting as Acute Appendicitis: A Case Report and Literature Review

Challenging differential diagnosis, Management of emergency care, Rare disease

Alexander H. Mimery1ABCDEF*, Joe Jabbour1ADE, Blake Sykes1ADE, Ewan MacDermid2ADE, Mohamed Al-Askari1ADE, Stefaan De Clercq1ADE

DOI: 10.12659/AJCR.921568

Am J Case Rep 2020; 21:e921568

Abstract

BACKGROUND: Appendicitis is the most common cause of an acute abdomen. Approximately 1% of appendicectomies will have an incidental finding of an appendiceal neoplasm. A primary appendiceal lymphoma is extremely rare, and is found in 0.015% of all appendiceal specimens. Burkitt lymphoma is an aggressive B cell lymphoma characterized by translocation and dysregulation of the c-Myc gene. Burkitt leukemia is considered to be an alternative manifestation of the same pathology, and is defined by the presence of >25% Burkitt blasts within the bone marrow. The treatment approaches for Burkitt leukemia/lymphoma are similar.

CASE REPORT: A 6-year old girl presented with a history, examination, and radiological imaging consistent with acute appendicitis. An inflamed, edematous appendix was identified intraoperatively, and a cecectomy was performed. Histopathological investigations demonstrated Burkitt leukemia with isolated extra-nodal involvement of the appendix. The patient was subsequently started on a multi-agent steroid and chemotherapy regimen. A literature review was performed, identifying cases of Burkitt leukemia/lymphoma presenting as appendicitis.

CONCLUSIONS: This case highlights the importance of clinical vigilance and routine specimen histopathology review, and explores key management considerations associated with the incidental diagnosis of Burkitt leukemia/lymphoma.

Keywords: Appendiceal Neoplasms, appendicitis, Burkitt Lymphoma, Abdomen, Acute, Antineoplastic Combined Chemotherapy Protocols, Appendectomy, Child, Diagnosis, Differential, Steroids

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923