Primary jejunal Burkitt lymphoma in a child: ultrasonic detection

Abstract

Gastrointestinal Burkitt lymphoma (BL) is a highly aggressive malignancy in childhood, and early treatment is critical for its favorable prognosis. Ultrasonography is a widely accepted initial imaging workup; therefore, recognition of the sonographic features of BL should contribute to its early diagnosis and initiation of treatment. We present a 4-year-old boy with primary jejunal BL with intussusception mimicking presentation, in which initial abdominal US allowed sustainable detection and characterization of the intestinal lesion. Jejunotomy was performed and histopathological analysis revealed a 'starry sky' pattern and c-myc split signals characteristic of BL. The patient remains disease-free following chemotherapy.

Figure 1:

(a) Supine abdominal radiograph at initial presentation demonstrates a bowel gas pattern with gaseous distension of the left-upper small bowel loops. (b) Focused sonography of the abdomen demonstrates a well-circumscribed area of low echogenicity in the lumen of the intestine, (c) and power Doppler sonography detected abundant blood flow signals in that area. The lesion was ~20 × 5 mm² in size. (d) A ‘target pattern’ was observed in the adjacent intestinal loops, which suggested intussusception. (e) CT scanning confirmed an intestinal intraluminal mass in the left-upper quadrant (white arrowhead). (f) Freshly exophytic tumor bulging into the jejunal lumen, involving half the circumference of the wall. (g) The tumor is composed of scattered pale tiny body macrophages on a dense background of monomorphic, intermediate-sized lymphocytes, creating a ‘starry sky’ pattern (lower left).