Makindo Medical Notes

ℹ️ About

• 🧬 Monoclonal proliferation of B lymphocytes.
• ⚡ Very aggressive form of non-Hodgkin lymphoma (<1% of B-cell lymphomas).
• 👨‍⚕️ First described by Denis Burkitt, Irish surgeon working in Africa (1950s).
• 🌍 Often seen in children and young adults; can affect multiple organs.

⚙️ Aetiology

• 🦠 First human tumour proven to be associated with a virus: Epstein–Barr Virus (EBV).
• 🩸 Cancer of the lymphatic system with rapid doubling time.
• 🧾 Most cases linked to translocations involving the MYC gene on chromosome 8.

🧬 Translocations

• t(8;14)(q24;q32) – most common (70%).
• t(2;8)(p12;q24).
• t(8;22)(q24;q11).

📂 Types

• 🌍 Endemic: Equatorial Africa; EBV-associated; often affects the jaw/face in children (4–7 yrs).
• 🌐 Sporadic: More common worldwide; abdominal and bone marrow involvement, adolescents/young adults.
• 🧩 Immunodeficiency-related: Linked to HIV/AIDS, post-transplant; often EBV-negative.

🩺 Clinical Features

• 👶 Predominantly in children/young adults.
• 🦷 Endemic: jaw/face swelling, tooth displacement.
• 🌡️ Sporadic: abdominal masses, bowel obstruction, hepatosplenomegaly.
• 🧠 Possible CNS, kidney, ovary, or marrow involvement.
• 🩸 Leukaemic phase: resembles acute lymphoblastic leukaemia (L3 morphology).

🧠 Differentials

• Diffuse large B-cell lymphoma (DLBCL).

🔬 Investigations

• 📊 Bloods: FBC, U&E, LFTs, Ca, LDH (raised in bulky disease).
• 🧪 Excisional biopsy = gold standard (starry-sky histology).
• 🔎 Flow cytometry for immunophenotype confirmation.
• 🖥️ Imaging: CT CAP + PET for staging.
• 🧠 Consider lumbar puncture (CNS spread common).

💊 Management

• 🚨 Staging must be rapid – therapy within 48h of diagnosis.
• 🔪 Surgical resection if large obstructive abdominal mass.
• 💉 High-intensity, short-duration combination chemotherapy: – CODOX-M/IVAC – BFM regimens – Rituximab often added.
• 💊 Supportive care: tumour lysis prophylaxis (allopurinol/rasburicase, hydration).
• 🧠 CNS prophylaxis with intrathecal methotrexate.
• 🧬 Stem cell transplantation: for relapse or refractory disease.

🧾 Case Vignettes

Case 1 – Endemic Burkitt’s 🦷 A 6-year-old boy from Uganda presents with a rapidly enlarging jaw mass and tooth loosening. Biopsy shows a starry-sky pattern and EBV positivity. 👉 Key point: endemic, EBV-driven, facial/jaw involvement. 👉 Management: urgent chemo ± rituximab, CNS prophylaxis.

Case 2 – Sporadic Burkitt’s 🌐 A 17-year-old male in the UK presents with acute abdominal pain and a palpable mass. CT shows ileocaecal mass with intussusception. 👉 Key point: sporadic type, GI involvement, emergency presentation. 👉 Management: surgery for obstruction, then intensive chemotherapy.

Case 3 – Immunodeficiency-associated Burkitt’s 🧩 A 32-year-old HIV-positive man with poor ART adherence presents with rapidly progressive cervical lymphadenopathy and night sweats. Biopsy confirms Burkitt lymphoma, EBV-negative. 👉 Key point: HIV-associated, aggressive course. 👉 Management: HAART optimisation + intensive chemo.

📚 References

• Burkitt Lymphoma – StatPearls
• BHS Guidelines for Burkitt’s Lymphoma
• Burkitt Lymphoma: Clinicopathologic Features – J. Ferry