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Burkitt lymphoma (or “Burkitt’s tumor”, or “Malignant lymphoma, Burkitt’s type”) is a cancer of the lymphatic system (in particular, B lymphocytes). It is named after Denis Parsons Burkitt, a surgeon who first described the disease in 1956 while working in equatorial Africa.[1][2]
Almost by definition, Burkitt’s lymphoma is associated with c-myc gene translocation. This gene is found at 8q24.
Currently Burkitt’s lymphoma can be divided into three main clinical variants: the endemic, the sporadic and the immunodeficiency-associated variants.[5]
By morphology (i.e. microscopic appearance) or immunophenotype, it is almost impossible to differentiate these three clinical variants. Immunodeficiency-associated Burkitt lymphoma may demonstrate more plasmacytic appearance or more pleomorphism, but these features are not specific.
Consists of sheets of monotonous (i.e. similar in size and morphology) population of medium size lymphoid cells with high proliferative activity and apoptotic activity. The “starry sky” appearance seen[7] under low power is due to scattered tingible-bodies laden macrophages (macrophages containing dead body of apoptotic tumor cells). The old descriptive term of “small non-cleaved cell” is misleading. The tumor cells are mostly medium in size (i.e. tumor nuclei size similar to that of histiocytes or endothelial cells). “Small non-cleaved cells” are compared to “large non-cleaved cells” of normal germinal center lymphocytes. Tumor cells possess small amount of basophilic cytoplasm. The cellular outline usually appears squared off.
Normal B cells possess rearranged immunoglobulin heavy and light chain genes, unlike most T-cells and other cells of the body in which the genes are germline. Each isolated B-cell possesses a unique IgH gene rearrangement, reminiscent of the fingerprint of a person. Since Burkitt lymphoma and other B-cell lymphomas are a clonal proliferative process, all tumor cells from one patient are supposed to possess identical IgH genes. When the DNA of tumor cells is analyzed using electrophoresis, a clonal band can be demonstrated since identical IgH genes will move to the same position. On the contrary, when a normal or reactive lymph node is analyzed using the same technique, a smear rather than a distinct band will be seen. This technique is useful since sometimes benign reactive processes (e.g. infectious mononucleosis) and malignant lymphoma can be difficult to distinguish.
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