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Burkitt lymphoma (BL)

Burkitt lymphoma (BL), a highly aggressive B-cell lymphoma, represents approximately 2.5% of all non-Hodgkin lymphomas (NHLs). BL preferentially involves extranodal sites, such as the small intestine or jaw, or may manifest as acute leukemia. The genetic hallmark of BL is a reciprocal translocation of the MYC gene on chromosome 8 most commonly with IGH gene or, alternatively, with the κ or λ immunoglobulin light chain genes.

The diagnosis of BL is based on a combination of morphologic, immunophenotypic, and cytogenetic findings. The distinction between BL and other high-grade B-cell lymphomas is clinically important, not only because BL is a tumor of extremely high proliferation rate but because patients are at special risk for central nervous system involvement. The morphologic features of BL—sheets of monomorphic medium-sized B cells with basophilic cytoplasm, numerous mitotic figures, and admixed macrophages (“starry-sky pattern”)—are not specific because lymphoblastic lymphoma, diffuse large B-cell lymphoma (DLBCL), plasmablastic lymphoma, and even a high-grade T-cell lymphoma can have this picture.


Evaluation of the tumor immunophenotype might help to differentiate BL from these entities. The characteristic immunophenotype of BL is a mature B cell with germinal center cell differentiation. The tumor cells are positive for B cell–associated antigens such as CD19, CD20, CD22, and CD79a and express surface immunoglobulins (SIgs) with light chain restriction and the germinal center cell markers CD10 and bcl-6. The tumor cells are negative for CD5, CD23, and terminal deoxynucleotidyl transferase (TdT) and usually negative for bcl-2; however, bcl-2 can be expressed in 10% to 20% of cases.

                                                                                                 CASE -1





























Case 1 showed several immunophenotypic deviations in addition to lack of SIg light chain expression. Case 1 have  expression of  B cell–associated antigens, CD19, CD20, CD22 and CD79a, by flow cytometry. Case 1 lack the expression of  CD10, CD15, NG2, CD3, cCD3, MPO, CD13, CD33 and CD7. they also expressed the CD38, CD123, CD58, CD81 and HLA-DR.


                                                                                                    CASE -2





















Case 2  have  expression of sIgM with  B cell–associated antigens, CD19, CD20, CD10 and CD79a, by flow cytometry. Case 2 lack the expression of  CD13, CD34, MPO, CD13. they also expressed the HLA-DR.


                                                                                                    CASE -3





















Case 3 showed  SIg light chain expression with  B cell–associated antigens, CD19, CD20, CD22,CD79a and Kappa lambda, by flow cytometry. Case 3 lack the expression of  CD10, MPO, CD13, cCD3, CD33 and CD34. they also expressed the CD38.


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