🦠 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

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Burkitt's lymphoma

ℹ️ About

⚙️ Aetiology