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Lymphoma - B cell neoplasms

B cell lymphoma subtypes

Burkitt’s lymphoma

Reviewer: Nikhil Sangle, M.D., University of Utah and ARUP Laboratories (see Reviewers page)
Revised: 7 February 2012, last major update February 2011
Copyright: (c) 2001-2011, PathologyOutlines.com, Inc.

See also Post-transplant Burkitt's lymphoma


● High grade B cell lymphoma characterized by CD10+ and c-myc translocation


Burkitt’s leukemia: tumor cells present in blood and diffuse marrow involvement at diagnosis; leukemic cases were previously classified as FAB-L3
B cell lymphoma, unclassifiable, with features intermediate between Burkitt lymphoma and diffuse large B-cell lymphoma: lymphomas with 2 translocations involving c-MYC and bcl2 or bcl6 (Am J Clin Pathol 2010;134:258)


● Either endemic, sporadic or immunodeficiency-associated
Endemic: tropical Africa, involves jaw or abdomen, 95% are EBV positive (Arch Pathol Lab Med 2004;128:549); malaria may facilitate EBV infection by affecting the EBV-specific T-cell response
Sporadic: seen throughout the world, mainly in young adults and children (median age of 30 years); high association with EBV in Brazil (Am J Clin Pathol 2008;130:946)
Immunodeficiency associated: adults, often HIV+; involves distal ileum, cecum, mesentery


● Due to c-myc translocation that causes increased constitutive levels of c-myc

Clinical features

● 30% of childhood lymphomas
● Curable with aggressive therapy in 60%
● Marrow involvement in 15-30%
● May present as B cell acute lymphoblastic leukemia / FAB L3 (also called Burkitt’s leukemia)
● Leukemic cases associated with involvement of ileocecum
CD5+ Burkitt's leukemia: elderly patients with leukemic tumor cells resembling Burkitt's lymphoma by morphology and immunostains (Am J Clin Path 1999;112:828); resembles blastoid variant of mantle cell lymphoma (c-myc negative, cyclin D1+)

Clinical images

Jaw tumors in African boys

Gross images

Ileocecal valve tumor-contributed by Dr. Kaveh Naemi, Irvine, California

Micro description

● Diffuse infiltration of monomorphic, medium-sized (10-25 micron) cells with abundant basophilic cytoplasm, non-cleaved round nuclei with coarse chromatin and 2-5 distinct nucleoli
● Mitotically active with starry sky pattern (stars are tingible body macrophages)
Bone marrow: usually diffuse infiltration of interstitium, with some preservation of adipose tissue; prominent mititoc figures; starry sky feature seen in lymph nodes is rare in marrow

Micro images

Bone marrow shows medium sized cells with cytoplasmic vacuoles

Starry sky pattern

Contributed by Dr. Kaveh Naemi, Irvine, California - ileocecal valve tumor

Burkitt's lymphoma versus diffuse large B cell lymphoma with c-myc

CD20+                         CD10+

bcl2                              Ki-67

Ki-67 and bcl2 are strongly positive (uncommon pattern for bcl2)

Positive stains

● CD10, CD19, CD20, Ki-67/MIB1 (almost 100%), surface immunoglobulin
● Also CD22, CD33 (myeloid antigen, J Clin Pathol 1993;46:778), CD43, CD79a, bcl6, surface IgM
● EBV positive in endemic African cases and AIDS cases
● Nuclear staining with new c-myc antibody (Am J Surg Pathol 2010;34:882)

Negative stains

● CD5, CD23, TdT, bcl2 (positive in 20%)

Flow cytometry

● Rare atypical immunophenotypes are negative for SIg light chain, B cell antigens and CD10, and positive for CD4 (Am J Clin Pathol 2010;134:127)

Cytology description

● Imprints demonstrate cytoplasmic lipid vacuoles; rarely granulomas (Am J Surg Pathol 2004;28:379)

Cytology images

Wright's stain

Breast lesion

Molecular description

● t(8;14)(q24;q32): c-myc and IgH (75%); also reported in some diffuse large B cell lymphomas, rarely mantle cell lymphoma
● t(2;8)(p12;q24): Ig kappa and c-myc (15%); rarely mantle cell lymphoma
● t(8;22)(q24;q11): c-myc and Ig lambda (10%)
● FISH is routinely used for diagnosis, although up to 10% cases lack MYC translocation by FISH; in these cases, PCR or other techniques may be helpful
● By gene expression profiles, is distinct from other B cell lymphomas (Blood 2011 Jan 18 [Epub ahead of print])

Molecular images


Differential diagnosis

PreB lymphoblastic lymphoma: usually present as leukemia, no surface immunoglobulin, TdT+, c-myc negative
Diffuse large B cell lymphoma with c-myc translocation: more pleomorphic cells, c-myc negative (usually), Ki67+ in 67% vs. 100% in Burkitt’s (Mod Pathol 2002;15:771)
CD10+ diffuse large B cell lymphoma with c-myc translocation: higher levels of CD44 and CD54 by flow cytometry (Am J Clin Pathol 2010;133:718)

End of Lymphoma - B cell neoplasms > B cell lymphoma subtypes > Burkitt’s lymphoma

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