Burkitt Lymphoma: Thorax to Pelvis

Case Report

Austin J Clin Case Rep. 2014;1(9): 1044.

Burkitt Lymphoma: Thorax to Pelvis

S.K. Verma*, Neha

Department of pulmonary Medicine, KGMU, Lucknow 226003, India

*Corresponding author: S.K. Verma, Department of pulmonary Medicine, KGMU, Lucknow 226003, India

Received: August 04, 2014; Accepted: September 03, 2014; Published: September 05, 2014


Burkitt lymphoma is a subgroup of non-Hodgkin’s lymphoma of high-grade which is aggressive and is composed of diffuse, undifferentiated malignant cells of lymphoid origin which are small and noncleaved. Dennis Burkitt first described this entity in 1956 in equatorial Africa. In humans, one of the fastest growing cancers is Burkitt lymphoma (BL), growth fraction close to 100%. Clinical course in Burkitt lymphoma is aggressive and rapid. It commonly occurs in children and young adults, with frequent involvement of bone marrow and central nervous system (CNS). These are considered to be medical emergencies and require immediate diagnostic and therapeutic intervention. Here we are reporting a case of Burkitt lymphoma with unusual presentation with involvement of both thorax and whole of the abdomen.

Keywords: Burkitt Lymphoma; Thorax; Pelvis; Children


In Indian children, Burkitt lymphoma; accounting for 0.76% of solid malignant tumors. It is very rare malignancy. Most of the cases reported in literature presented either as jaw tumors or intra-abdominal malignancy and to the best of our knowledge, there is no Burkitt lymphoma case mimicking ours which presented as mass extending from thorax into abdomen and pelvis in continuity and hence we are reporting this case.

Case Presentation

A 16-year old non smoker male, presented to our outpatient department, with chief complaints of fever for 3 months, progressive breathlessness and left sided chest pain since 2 months. Fever was low grade, continuous, relieved on taking medications. Breathlessness was insidious in onset, gradually progressive initially MMRC grade 1 later on MMRC grade 4, increased on lying in right lateral position. Chest pain was insidious in onset, gradually progressive, localized to left side of hemi thorax, non-radiating, no diurnal or postural variation. Patient also complained of abdominal distention since 1 month which was progressive in nature and was associated with dull aching pain. There was no history of cough, hemoptysis, pedal edema, altered bowel habits, recurrent vomiting and reflux. On initial examination, patient was having a respiratory rate of 30/min and oxygen saturation of 92%. His Blood Pressure was 112/80 mmHg and pulse rate was 110/min. On general examination, pallor was present. Left axillary (4cmx3cm, single, mobile, firm) and left supraclavicular (2cmx1cm, single, mobile and firm) lymph nodes were palpable. On Respiratory System Examination, chest was asymmetrical with fullness on left hemi thorax, dilated veins present on left side of the chest, movement diminished on left side. Trail sign was present with right sided tracheal shift, apex beat was palpable in right 5th inter costal space medial to mid clavicular line. On percussion dull note was present over left hemi thorax. On auscultation, breath sounds diminished on left hemi thorax with decreased vocal resonance on left side. Per abdominal examination revealed tense and tender abdomen. Evaluation of rest of the systems was within normal limits. X ray chest PA view revealed left sided homogenous opacity with shift of trachea as well as mediastinum towards right side (Figure 1). USG whole abdomen was suggestive of a heterogenous predominantly hypoechoic lesion with internal vascularity covering whole abdomen extending from epigastrium mainly on left side to pelvis pushing the intra-abdominal vessels to right and bowel loops posteriorly with mild peritoneal collection. CT scan Thorax and abdomen was done which was suggestive of large ill defined heterogeneously enhancing soft tissue attenuation lesion extending from left hemithorax into abdominal cavity up to pelvis? Malignant (Figure 2,3,4). FNAC of left axillary lymph node showed population of abnormal cells with dual population, majority being large cells with moderate amount of cytoplasm with vacuolation. Nuclear chromatin is coarse, majority of cells showed round nuclear outline. Cytomorphology was suggestive of non Hodgkin’s lymphoma (Burkitt type) (Figure 5,6). Bone Marrow examination revealed early lymphomatous infiltration. However, the patient’s attendants denied further workup and treatment.