Burkitt lymphoma HIV

Case contributed by A.Prof Frank Gaillard

Presentation

HIV +ve. Loss of weight and PR bleeding. Distended abdomen.

Patient Data

Age: 35
Gender: Male
Modality: CT

Chest:

There is a 6cm x 4 cm mass in the right atrium consistent with tumour thrombus. A small pericardial effusion is noted.

Incompletely imaged there is expansion of a left lower lobe pulmonary vessel by a low density filling defect, also consistent with tumour thrombus. As this vessel is located next to the left interior pulmonary vein, the tumour thrombus is almost certainly located within a pulmonary artery.

Abdomen: 

Multiple mass lesions are demonstrated within the hepatic parenchyma with the largest lying in segment 2 and this appears to have several associated mass lesions adjacent to it.

There is significant enlargement of the adrenals bilaterally. 

There is poor enhancement of the right kidney in comparison to the left. This appears to be secondary to compression of the right renal artery at the level of the renal hilum secondary to the presence of a mass lesion. There is dilatation of the renal collecting system. Multiple renal mass lesions are demonstrated with enlargement of the right kidney.

There is poor enhancement of the anterior and medial aspect of the left kidney at the level of the renal hilum with the presence of a mass lesion. This appears to be extending down the left ureter with marked enlargement of the left ureter proximally. There is no significant dilatation of the renal collecting system. Multiple mass lesions are seen associated with the left kidney with enlargement of the left kidney.

Tumour thrombus in both renal veins. 

There is significant enlargement of the prostate. The prostatic mass lesion appears to be causing obstruction of the distal right ureter.

There is significant compression of the IVC secondary to the large right adrenal mass lesion. A filling defect is present within the intrahepatic IVC which may represent the presence of thrombus.

There is satisfactory enhancement of the spleen.

There appears to be a large mass lesion associated with the pancreas which measures up to 3.6 cm x 3.9 cm in size. 

There is satisfactory enhancement of the SMV and the splenic vein which are displaced by the adrenal mass lesions and there is satisfactory enhancement of the portal vein,though minor compression secondary to the adrenal mass lesion and hepatic mass lesions.

There appear to the omental metastases associated with a mass lesion at the inferior pole of the liver.

There is wall thickening of the ascending colon and hepatic flexure and the bowel iscollapsed down. The possibility that this represents the presence of a mass is difficult to exclude. There is no obstruction to the small or large bowel loops with contrast seen extending throughout to the level of the splenic flexure. There is a slightly desmoplastic appearance to the loops of small bowel within the midabdomen to the left of midline with some clumping present. It is difficult to clearly delineate a definitive mass lesion. No source for the documented PR bleeding is demonstrated.

A soft tissue mass lesion is present within the ischiorectal fat on the left measuring up to 3.5 cm x 1.4 cm in size.

Skeleton:

Multiple lucent lesions are seen within the axial skeleton. Several of these demonstrate a slightly sclerotic centre and margin. There is a lucent and erosive lesion involving the left sacral ala extending to involve the sacroiliac joint.

 

Case Discussion

The patient went on to have a core biopsy. 

Histology

MICROSCOPIC DESCRIPTION: Sections show multiple cores of tissue which shows a diffuse population of large atypical cells. The cells have large irregular nuclei with small nucleoli and a moderate amount of eosinophilic cytoplasm. The cell nuclei are irregular and folded. Mitotic figures are present. There is prominent apoptosis.

 

  • Immunohistochemistry shows cells stain:
    • positive with CD20, CD10, Bcl-6, c-myc and p53.
    • negative with Bcl-2, Cyclin- D1,MUM-1, CD23, CD5 andCD3.
  • Ki67 >95%.
  • EBER-CISH positive. EBV-LMP focal positive. HHV-8 and TdT negative.

DIAGNOSIS: Features support the diagnosis of a Burkitt Lymphoma.

 

Burkitt lymphoma is known to occur in patients who have had extended immunosuppression and thus was recognised early as one of the malignancies seen in HIV / AIDS. 

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Case Information

rID: 32685
Case created: 9th Dec 2014
Last edited: 17th Sep 2016
Inclusion in quiz mode: Included

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