PMC4896235_01
15-year-old male with Burkitt's lymphoma. Abdominal radiograph shows mucosal thickening in a loop of bowel in the patient's right hemipelvis. There is a soft tissue fullness overlying the right sacroiliac joint that may represent a mass. Moderate amount of stool and gas are presented in the ascending and transverse colon with no evidence of obstruction or calcification.
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A radiograph of the abdomen demonstrated soft tissue fullness overlying the right sacroiliac joint and mucosal thickening in a loop of bowel in the right pelvis (Fig. 1).
15-year-old male with Burkitt's lymphoma. Chest radiograph shows normally inflated lungs without evident hilar adenopathy. There is some blunting of the right costophrenic angle (arrow).
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Chest radiograph (Fig. 2) demonstrated blunting of the right costophrenic angle thought to be due to either pleural thickening or pleural fluid.
15-year-old male with Burkitt's lymphoma. CT with contrast. (A) The bulky heterogenous mass (M) measured 6 cm. in AP dimension and 7 cm in transverse dimension. Contrast material from the lumen of the bowel is seen around it, suggesting that the mass arises from the bowel wall. (B) A smaller mass (M) in the patient's pelvis located left of the rectum and posterior to the bladder. It measures 5.8 cm in transverse dimension, 4.2 cm in AP dimension. (C)Coronal reconstruction of the Abdominal/Pelvis CT. The right lower quadrant mass (M), measured 12 cm in Superior-Inferior (SI) dimension, appears to infiltrate the bladder wall and displaces it from left to right. There is a tubular structure (arrow) that is seen extending from the large mass and draping over the colon. This may represent an infiltrated and enlarged appendix. There is abnormal thickening of the diaphragm adjacent to the liver (*).
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Abdominal/Pelvis CT with contrast showed a large heterogenous mass (Fig. 3A) infiltrating the wall of the terminal ileum, cecum and mesentery with evidence of metastasis to the omentum, the diaphragm and the pelvis. A smaller mass was also identified in the pelvis posterior to the bladder (Fig. 3B).
15-year-old male with Burkitt's lymphoma. Hematoxylin and eosin (H&E) stained microscopic images from bone marrow aspiration clot (A) and from mass in the right lower quadrant (B) demonstrating sheets of medium size lymphoid cells with high mitotic activity interspersed with macrophage forming "starry-sky" pattern.
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Pathologic examination (Fig. 4B) demonstrated sheets of small to medium size lymphoid cells. Further studies revealed involvement within the bone marrow (Fig. 4A), at 42% of marrow cells, making the diagnosis of Burkitt's Leukemia (rather than Lymphoma) more applicable.
15-year-old male with Burkitt's lymphoma. Immunohistochemical stains showing positive leukocyte common antigen (A), CD20 (B), CD79a (C), Kappa light chains (D), negative Lambda light chains (E) and Diff-Quick stained Touch prints cytology (F).
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Immunohistochemical stains (Fig. 5) were positive for CD45 or leukocyte common antigen (LCA).
15-year-old male with Burkitt's lymphoma, two months after initiation of chemotherapy. (A) The superior mass (M) measured 50 mm in transverse dimensions, 39 mm in anterior-posterior dimension. Compared to the previous study, the mass showed interval decrease in size and increase in the amount of central low attenuation consistent with increased tissue necrosis. (B) The inferior mass (M) associated with the terminal ileum now measured approximately 29 mm in transverse dimension, 23 mm in anterior-posterior dimension. The lumen of the terminal ileum is discernible in this study. Some discreet lymph nodes are seen around the mass (arrows). (C) The previously seen pelvic mass shows significant reduction in size. In this study, only minimal amount of enhancing soft tissue (M) measuring approximately 10 mm in thickness is appreciated.
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Abdominal/Pelvis CT with contrast [Fig. 6] two months after initiation of chemotherapy revealed that the original mass which involved the terminal ileum and cecum is now seen as two discrete masses. The superior mass involved the mesentery located just superior to the terminal ileum [Fig. 6A] while the other is at the terminal ileum itself [Fig. 6B]. The mass in the pelvis [Fig.6C] was also significantly decreased in size.