HIV-related Burkitt lymphoma with florid granulomatous reaction: an unusual case with good outcome

Abstract

Burkitt lymphoma (BL) is a highly aggressive subtype of non-Hodgkin lymphomas (NHL). Lymphoma related granulomatous reaction rarely occurs in sporadic BL. Herein, we describe the first case of HIV related Burkitt lymphoma with florid granulomatous reaction. A 41-year-old HIV-positive Chinese male presented lymphadenopathy in the right cervical region for 3 months. The enlarged lymph node biopsies revealed the presence of prominent granulomas of varying size with Langhans giant cells, leading to the misdiagnosis of tuberculous lymphadenitis in other hospital. Subsequently, the case was sent to us for consultation. The morphology, immunophenotype, special staining, interphase FISH analysis and blood tests confirmed a diagnosis of HIV related Burkitt lymphoma with granulomatous reaction. Without radiotherapy and chemotherapy, the patient was alive and well with no evidence of lymphoma during the observation period of 24 months. The case suggested that lymphoma with florid granulomatous reaction can easily be misdiagnosed as benign lesions since the large number of epithelioid granulomas could obscure the primary lesion. Moreover, the granulomatous reaction may be an indicator for favorable prognosis in HIV related Burkitt lymphoma.

Keywords: Human immunodeficiency virus related Burkitt lymphoma; granulomatous reaction; prognosis.

Figure 1

Prominent granulomas of different size are identified (H&E × 100) (A). Langhans giant cells are fairly easy to be observed in granulomas (H&E × 400) (B). “Starry sky” pattern is obviously seen (H&E × 200) (C). Medium sized cells present round or oval nuclei with finely clumped and dispersed chromatins and 2~4 basophilic (H&E × 400) (D).

Figure 2

Immunohistochemistry (A-C). Atypical lymphocytes are positive for CD20 (A), CD10 (B), and nearly 100% of atypical lymphocytes are positive for Ki-67 (C) (× 200). EBER-ISH shows positive signal in atypical lymphocytes, while histiocytes are negative (D) (× 200).

Figure 3

Representative interphase FISH results. FISH study using MYC dual-color break-apart rearrangement probe detects a dissociation of the red and green signals (A). IGH/MYC dual color, dual-fusion translocation probe shows two fusion signals (B). FISH study using BCL2 dual-color break-apart probe and BCL6 dual-color break-apart probe show no dissociative signal (C, D).