Burkitts Lymphoma

Question 1

What are the to main types of lymphoma?

Answer 1

Non-hodgkins and Hodgkins

Question 2

What is the commonest childhood cancer in tropical Africa?

Answer 2

Non-Hodgkins Lymphoma

Question 3

What is the malignant solid tumor of B or T cell lymphocytes?

Answer 3

Non-Hodgkins lymphoma

Question 4

Age range for non-hodgkins and peak age

Answer 4

4-9 years, peak 5 years

Question 5

Rare age ranges for Non-Hodgkins lymphoma

Answer 5

<2years and >16years

Question 6

Gender ratio of Non-hodgkins lymphoma?

Answer 6

Males:females
2:1

Question 7

Favourable prognosis for NHL?

Answer 7

Minimal therapy in early stages

Question 8

General symptoms for NHL?

Answer 8

No. Depends on location of tumor

Question 9

Clinical presentation of NHL in the head and neck.

Answer 9

1. Neck or jaw mass involving nasopharynx, sinuses-painless or painful
2. Proptosis
3. Dental anarchy
4. Breathing or swallowing difficulty

Question 10

Clinical presentation of NHL in the abdomen

Answer 10

1. Abdominal mass +/- ascites
2. Abdominal pain
3. Nausea and vomiting, constipation +/- bowel obstruction
4. Urinary retention
5. Spinal cord compression- paraplegia

Question 11

Clinical presentation of a T cell lymphoblastic lymphoma

Answer 11

1. Cough, stridor, dyspnea +/- pleural effusion +/- SVC obstruction
2. Hepatosplenomegaly

Question 12

Features of Endemic type?

Answer 12

5-10 years
Male>female
Common in Africa, Brazil and Turkey
Jaw, abdomen, CNS, CSF
95% - Epstein Barr Virus
Rapidly growing tumor of the jaws or abdomen in high risk groups with doubling time of 24 hours.
Short duration of PC.

Question 13

Features of Sporadic type

Answer 13

6-12 years
Male>female
Abdomen, bone marrow, lymph nodes, ovaries.

Question 14

Diagnosis of endemic type

Answer 14

Biopsy for histology
😻 starry sky appearance

Question 15

What are the sanctuary sites for Burkitts lymphoma?

Answer 15

Indication of poor prognosis
Testes
Breasts
Thyroid gland
Pancreas
Skin
Epidural space
Bone

Question 16

What hematologic investigations will you do and what do you expect?

Answer 16

Full Blood Count - to rule out leukemia
Blood film comment
Renal and Liver Function tests
LDH( lactic acid dehydrogenase) - raised in Non-Hodgkins lymphoma
Uric acid- increased in high tumor burden
HIV test

Question 17

What imaging investigations will I do?

Answer 17

Chest X-ray for mediastinal mass
Abdominal and /or neck ultrasound
CT scan / MRI
Echocardiogram- ejection fraction of doxorubicin administration.
Needle biopsy
Pleural or ascites fluid
Bone marrow aspirates + trephine for staging
Lumbar puncture- CNS status
Immunohistochemistry

Question 18

What is stage A?

Answer 18

Single extrabdominal tumor site

Question 19

Stage B?

Answer 19

Multiple extra abdominal site

Question 20

Stage AR?

Answer 20

Completely (>90%) resected intraabdominal tumor.

Question 21

Stage C?

Answer 21

Intraabdominal tumor without involvement of other sites

Question 22

Stage D?

Answer 22

Intraabdominal and Extra abdominal tumor sites

Question 23

Treatment
Cycle 1/Prephase

Answer 23

Oral medications with Cyclophosphamide, Prednisolone and Allupurinol

Question 24

Alternate treatment cycle

Answer 24

Vincristine, Doxorubicin, Cyclophosphamide, prednisolone.
Intrathecal with
Cytarabine, vincristine, cyclophosphamide, prednisolone-

Question 25

Treatment regimen

Answer 25

Each cycle for 3 weeks after 3 weeks of no drugs.
Minimum of 6 cycles and maximum of 10 cycles

Question 26

Prognostic factors

Answer 26

Tumor burden is unfavorable if it’s high
Bone marrow involvement
CNS involvement
Presentation above 13 years
Relapse shortly after remission( 3 months) has poor prognosis