Burkitt's

Lymphoma .

* common childhood cancers .

1. Burkitt 's lymphoma - most common 1st

2. Klim 's tumour .

4th

3. HAL 2nd

4- Retinoblastoma .
3rd

Differentials of jaw swelling .

1. Burkitt 's
lymphoma -

2- Dental cyst

3- Jaw abscess .

4. osteoma of the jaw

Lymphoid tissue

Lymphoid tissue consists

of

Lymphocytes (a WBC ) and

type
•

of ,

Accessory cells such

macrophages and reticular cells
•
as .

The role cellular and

the
lymphoid tissue to Mount
*
of is immune response
.

Primary lymphoid tissue :B / bone

origin ) and Tlthymus origin )
cell -

Secondary lymphoid tissue

lymph nodes tonsils ,
spleen Peyer 's patches
•

: .

, ,

Lymphoma .

Definition :
Neoplasm of the lymphoid tissue

Types of lymphomas

1-
Hodgkin 's lymphoma .

2. Non-Hodgkin's lymphoma .
 Features of Hodgkin 's Lymphoma .

Reed
1. -

sternberg cells on
histopathology .

" "
Is lymphoma
2. a
good .

often starts single closely related nodes

lymph node
lymph before to others
•
in a or a
group of it
spreads
- .

Spreads orderly and predictable

•
in a more manner
.

Has
3. a
good prognosis

4- Has predictable clinical

symptoms
-

staging of Hodgkin 's lymphoma

.

Done Ann Arbor

staging
using
.

Features of Non-Hodgkin's lymphoma

1.
spreads unpredictably

Is
2.
very aggressive
.

3- Absence
of Reed -

Sternberg 's cells

4. Bad
prognosis

5. It develops
is
malignant and from B and T cells -

Examples Burkitt 's AN

lymphoma lymphoma follicular lymphoma
:
cats .

, , ,

Burkitt's lymphoma .

It is a
high grade malignant non-Hodgkin's lymphoma of B- all origin
-

Aetiology .

•
It is associated with .

I. Epstein-Barr virus (EBV )

Human LHNJ
2.
immunodeficiency virus

chromosomal translocations that

'

3 the
of c-
overexpression
cause
oncogene myc
.
 classification of Burkitt 's
lymphoma .

1. Endemic

2-
Sporadic
3-
Immunodeficiency associated

The and different

*
types are
histologically identical but
epidemiologically genetically
-

Endemic Burkitt 's

Lymphoma .

1. It is common in
equatorial Africa

involves the and ( facial jaw swelling)

2-
Mainly jaw facial bones and -

children 4-7
aged
3-
commonly affects years
-

Sporadic Burkitt's
lymphoma .

I. occurs worldwide .

2.
Mainly affects the abdomen :
kidney ,
intestines ,
ovaries etc .

3.
Usually found in older individuals .

Immunodeficiency -
associated Burkitt's
lymphoma .

Found in HIV

organ transplant -

clinical features of Burkitt 's lymphoma

-

1-
Lymphadenopathy :
Palpable , firm , non - tender and rubbery lymph nodes

I. Pallor and other

signs of anemia : Dizziness , fatigue , palpitations

3-
Splenomegaly
.

Investigations
Fine
1. needle
aspiration of the lymph node for histopathological analysis

starry sky appearance

•
-
 Management of Burkitt 's lymphoma .

Done to reduce tumour

I.
Surgery size
-

2.
chemotherapy -
To clear remnants .

Agents / Drugs
•

1-
cyclophosphamide

2- Vincristine

3. Doxorubicin

4. Methotrexate

5- lfosfumide

6.
Etoposide

Complications of chemotherapy .

1- Tumour lysis syndrome .

It refers to the release of intracellular due to the effects

components of chemotherapeutic agents .

occurs 48-72 hours after therapy

•
-

•
Nucleic acid and
phosphates are released
from the nucleus-

•
Potassium is released from the cytosol .

-
-

•
Nucleic acid →
Xanthine /
hypoxanthine → uric acid →
hyperuricemia →
precipitation in renal tubules → AKI
,
Metabolic acidosis .

Hyperphosphaturia →
Reflex hypocalcemia
→
Renal osteo dystrophy
•

Hyperkalemia .

A 6
ylo is
being managed for a
malignant condition .

cyclophosphamide is administered ◦ several hours later the

,
child produces

very scanty urine .

24 hours later , urine production stops .
 a.
Diagnosis : Att
secondary to tumour
lysis syndrome .

b. List the biochemical

expected changes
1-
Hyperkalemia .

2-
Hyperphosphaturia .

3-
Hypocalcemia .

4.
Hyperuñcemia
5- Metabolic acidosis .

Cklhat could you

have done to prevent as ?

d.
Management

Triggers of Tumour lysis syndrome -

1.
Pre-existing oliguria
-

2-
Pre-existing volume depletion (
dehydration ]
B.
Pre-existing AM

4- sensitivity to chemotherapeutic agents

.

5.
Bulky tumour
.

How to Tumour
prevent Lysis syndrome
1.
Hydrate
2- Administer twice the normal maintenance amount

Holliday -

segar rule

Avoid foods high potassium and ( banana plantain waters

3- in
phosphates , ,
coconut .

4- Allopurinol ( Xanthine oxidase inhibitor ) -

Prevents conversion of nucleic acid to uric acid .

Treatment of Tumour lysis syndrome .

*
Hydrate
2. Treat hyperkalemia .

3- Treat hyperphosphatemics with oral phosphate binders

4. Calcium levels will correct
by itself after giving phosphate binders If not administer calcium gluconate
.
.

5- If no urine still ,s*end for dialysis

.