Burkitt's Lymphoma: Clinicopathologic Features and Differential Diagnosis

Abstract

Learning Objectives: After completing this course, the reader will be able to: Describe the events leading to the initial identification and description of Burkitt's lymphoma and the discovery of its association with the Epstein-Barr virus.Outline the WHO Classification of Burkitt's lymphoma, including the clinical and pathological variants of this lymphoma.Discuss the treatment strategies used for treating Burkitt's lymphoma.List the criteria for establishing a diagnosis of Burkitt's lymphoma and discuss the entities that may enter its differential diagnosis. Access and take the CME test online and receive 1 AMA PRA category 1 credit at CME.TheOncologist.com Burkitt's lymphoma is a highly aggressive lymphoma identified and described in the last century by Denis Burkitt in Africa, in areas endemic for malaria. Since its description in African children, it has been recognized outside areas with endemic malaria, frequently also in children as well as among individuals with an underlying immunodeficiency. Since its initial designation as Burkitt's lymphoma, this type of lymphoma and lymphomas closely resembling it have received a variety of names in different classifications of lymphomas and leukemias: undifferentiated lymphoma, Burkitt's and non-Burkitt's type in the modified Rappaport Classification, malignant lymphoma, small non-cleaved cell, Burkitt's type in the Working Formulation, Burkitt's lymphoma and high-grade B-cell lymphoma, Burkitt-like in the REAL Classification, and acute lymphoblastic leukemia, L3 type in the FAB Classification. With the publication of the WHO Classification of Haematopoietic and Lymphoid Tumors, the nomenclature of this lymphoma has come full circle, and it is once again known simply as Burkitt's lymphoma. In recent years, efforts have focused on improving therapy for this rapidly proliferating neoplasm while minimizing, to the extent possible, treatment-associated toxicity. These efforts have led to the development of high-intensity, short-duration combination chemotherapy that has proven extremely effective for a high proportion of Burkitt's lymphoma patients. The differential diagnosis of Burkitt's lymphoma is broad, and precise diagnosis based on histologic, immunophenotypic, and genetic features remains the critical first step in planning appropriate therapy.