Diagnosis of Burkitt's lymphoma in due time: a practical approach

  • SB Cogliatti1,

    Affiliated with

    • U Novak2,

      Affiliated with

      • S Henz3,

        Affiliated with

        • U Schmid1,

          Affiliated with

          • P Möller4 and

            Affiliated with

            • TFE Barth4

              Affiliated with

              Diagnostic Pathology20072(Suppl 1):S6

              DOI: 10.1186/1746-1596-2-S1-S6

              Published: 14 March 2007

              Aims

              The quick diagnosis of Burkitt's lymphoma (BL) and its clear-cut differentiation from diffuse large B-cell lymphoma (DLBCL) is of great clinical importance since treatment for these two disease entities differ markedly and should promptly be initiated in BL. However, these two tumours are difficult to distinguish using the current WHO classification, particularly in regard to BL variants, i.e., BL with plasmacytoid differentiation and atypical Burkitt's/Burkitt's-like lymphomas.

              Methods

              We studied 39 cases of highly proliferative blastic B-cell lymphoma (HPBCL) to establish a practical differential-diagnostic algorithm. Characteristics set for BL were a typical morphology, a mature B-cell phenotype of CD10+, Bcl-6+ and Bcl-2- tumour cells, a proliferation rate of >95%, and the presence of C-MYC rearrangements in the absence of t(14;18)(q32;q21). All cases were selectively negative for cyclin D-1, CD5, CD23, LMP-EBV, CD34 and TdT, and there were no cases of endemic or immunodeficiency-associated Burkitt's lymphoma.

              Results

              Altogether the set BL characteristics were found in only 5/39 cases (12.8%), whereas the majority of tumours revealed mosaic features (87.2%). In a second attempt, we followed a pragmatic stepwise approach for a classification algorithm that includes the assessment of C-MYC status to stratify HPBCL into four predefined diagnostic categories (DC), namely DC I (5/39, 12.8%): "classical BL", corresponding to the classical variant of sporadic BL in the WHO classification; DC II (11/39, 28.2%): "atypical BL", corresponding to the atypical Burkitt's/Burkitt's-like variants of sporadic BL in the WHO classification; DC III (9/39, 23.1%): "C-MYC + DLBCL"; and DC IV (14/39, 35.9%): "C-MYC - HPBCL".

              Conclusion

              This proposal may serve as a robust and objective operational basis for therapeutic decisions for HPBCL within one week and is applicable to be evaluated for its prognostic relevance in prospective clinical trials.

              Authors’ Affiliations

              (1)
              Department of Pathology, Kantonsspital, St. Gallen
              (2)
              Institute for Cancer Genetics, Columbia University
              (3)
              Department of Internal Medicine, Kantonsspital, St. Gallen
              (4)
              Department of Pathology, University Hospital

              Copyright

              © Cogliatti et al 2007

              This article is published under license to BioMed Central Ltd.

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