Burkitt's lymphoma in Greek adults. A study of the Hellenic co-operative oncology group

Diagnosis and treatment of primary gastrointestinal Burkitt-like lymphoma in adults

AIM: To investigate the epidemiological and clinicopathological characteristics, diagnosis and treatment of primary gastrointestinal Burkitt-like lymphoma in adults.

METHODS: Relevant articles published since 1995 were retrieved in 15 English databases such as MEDLINE/PubMed, Web of Science, Directory of Open Access Journals (DOAJ) and SpringerLink and in China National Knowledge Infrastructure (CNKI) database. Data of six patients with primary gastrointestinal Burkitt-like lymphoma were obtained from six articles.

RESULTS: Four cases of adult primary gastrointestinal Burkitt-like lymphoma were from East Asia (Japan and China, 66.7%). All six patients were male with an average age of 57.6 years. Two cases occurred in the ileocecum, one in the stomach, one in the hepatic flexure of the colon, one in the terminal ileum, and one in the stomach and small intestine simultaneously. Four cases were admitted to the hospital because of abdominal mass, along with B symptoms: weight loss in four cases and fatigue in two cases. All patients underwent alimentary endoscopy (CT scan in 5 cases and B-ultrasound in 3 cases). Four cases underwent surgery, 5 cases underwent combined chemotherapy, and 3 cases underwent surgery plus postoperative chemotherapy. One case died within 1 year, and one case was followed for 5 years and is still alive. Immunohistochemically, CD20 and CD10 staining was positive in 4 cases, Ki-67 staining positive in 3 cases, Bcl-2 staining negative in 3 cases, CD23 and CD5 staining negative in 2 cases.

CONCLUSION: Adult primary gastrointestinal Burkitt-like lymphoma is a highly malignant non-Hodgkin's lymphoma and is extremely rare clinically with rapid development and high mortality. Its clinical manifestations are non-specific, so comprehensive examination should be conducted to confirm the diagnosis before clinical intervention. Final diagnosis still relies on fine-needle aspiration biopsy or surgical excision biopsy. Surgical treatment and multi-drug combination adjuvant chemotherapy postoperatively should be implemented as soon as possible after making a diagnosis. Clinicians should raise their awareness of the disease and pay more attention to the diagnosis and treatment of the disease, which could improve the outcome of the patients.

Adult B-Cell Lymphomas With Burkitt-Like Morphology Are Phenotypically and Genotypically Heterogeneous With Aggressive Clinical Behavior

Adult, de novo B-cell lymphomas meeting the WHO morphologic criteria for atypical Burkitt/Burkitt-like lymphoma cause diagnostic difficulty for pathologists because the genetic and clinical characteristics of this group of lymphomas have not been clearly defined. Thirty-one such lymphomas, designated as Burkitt-like lymphomas (BLL), were selected based on morphologic features and evaluated for immunophenotype, MYC and BCL2 status, and clinical features. Nine childhood Burkitt lymphomas (BL) and 87 adult, de novo diffuse large B-cell lymphomas (DLBL) were similarly evaluated for comparison. The BL group demonstrated uniform characteristics: all had Burkitt lymphoma morphology, an identical immunophenotype (positive for CD20, CD10, bcl-6, CD43, and p53; negative for CD138, CD23, bcl-2), high MIB-1 positivity, IGH/MYC translocation, no IGH/BCL2 translocation, and all patients were alive at the last follow-up. The BLL and DLBL groups were heterogeneous. Burkitt-like morphology alone correlated with decreased survival. IGH/MYC or IGL/MYC fusion was identified in 11 of 27 (41%) BLL and 4 of 76 (5%) DLBL and was associated with decreased survival in both groups. MIB-1 positivity did not correlate with morphology, MYC abnormalities, or survival. We propose that adult B-cell lymphomas with BLL morphology are a phenotypically and genetically heterogeneous group of aggressive lymphomas, biologically distinct from childhood BL. Until biologically accurate subgroups within this morphologically defined group are identified, it is appears that both recognition of BLL morphology and direct evaluation for the presence of MYC fusion to immunoglobulin genes are important for identification of adult patients with poorer prognosis than those with DLBL.

Adult Burkitt's Lymphoma

Burkitt's lymphoma is a mature B-cell lymphoma that is characterized by a rapid proliferative rate and propensity for extranodal sites of involvement such as the gastrointestinal tract and central nervous system. This subtype of non-Hodgkin's lymphoma is associated with unique cytogenetic translocations involving the c-MYC oncogene on chromosome 8, which appears to be involved in the pathogenesis of this disease. Although current literature is limited by a lack of randomized trials, Burkitt's lymphoma appears to be curable in a high proportion of cases if treated with aggressive multiagent chemotherapy regimens. The use of autologous stem cell transplantation appears to benefit patients who have had chemotherapy-sensitive relapses. The role of allogeneic stem cell transplantation for this disease remains uncertain. Patients with HIV-associated Burkitt's lymphoma appear to have a better prognosis today, which is likely a result of more effective antiretroviral therapy and the ability to treat selected patients with more aggressive chemotherapeutic regimens than before. This article will review the epidemiologic, biologic, diagnostic, and therapeutic aspects of Burkitt's lymphoma in adults.

Gender and age-related differences in Burkitt lymphoma--epidemiological and clinical data from The Netherlands

Although Burkitt's lymphoma (BL) is classified as one entity in the World Health Organisation (WHO) classification, we wondered whether BL should not be considered as a different disease in children compared with adults. Netherlands Cancer Registry (NCR) data were obtained from 1994 to 1998 (n=203). Detailed clinical data from two treatment protocols were compared: one for adults up to the age of 65 years (n=27) and one for children (n=80). All slides of the two clinical studies were centrally reviewed which included immunophenotyping and when necessary breakpoint analysis of MYC/8q24. Only cases with an unambiguous diagnosis of BL (classical and atypical BL) were accepted. The age distribution of BL-patients showed a bimodal distribution with a peak at the paediatric age and a steady increase after approximately 60 years of age. Most of the patients were males (89% for children and 78% for adults) and only male patients showed this bimodality. Children more often had extranodal disease (81% vs. 59%), whereas adults more often had nodal disease (89% vs. 53%). Based on epidemiology and clinical presentation, the concept that BL is one disease should be re-challenged.