Diagnosis of Burkitt Lymphoma

Clinical presentation in extranodal and nodal sites of rapidly expanding masses in high-risk populations suggests Burkitt lymphoma (BL). Most patients present with advanced disease because of the rapid rate of tumor growth. BL cells have a remarkably short doubling time. Children in equatorial Africa and Papua New Guinea have endemic BL and present with facial tumors in the jaw or orbit, abdominal masses, enlarged gonads or bilateral massive enlargement of breasts, particularly if malignancy onset is associated with puberty, pregnancy, or lactation. Over 50% of such presenting tumors in the Burkitt Belt will be BL [ 1 ] . If the clinical presentation is an African adult with lymphadenopathy and suspected lymphoma, BL is less likely unless the patient is HIV infected. Longer standing HIV-associated lymphadenopathy can mislead clinical diagnosis away from BL which is classically associated with acute onset expansive tumor growth. BL is a common lymphoma subtype in HIV worldwide including regions of sub-Saharan Africa outside the Burkitt Belt where BL was previously uncommon [ 2 ] . The “jaw tumor” in equatorial Africa is the classic, most recognized BL clinical presentation but worldwide facial tumors constitute a small percent of BL and all presenting jaw and abdominal tumors are not BL [ 3, 4 ] . Sub-Saharan African diagnosticians expect that aspiration smears, tissue imprints, or tissue biopsies from most body sites can harbor BL. Figure 2.1 the diagnostic