Page 174 - Haematologica Atlas of Hematologic Cytology

Figure 31. Burkitt lymphoma. A 58-year-old wo- man was admitted because of fatigue, bone pain, and cutaneous purpura. Physical examination re- vealed small peripheral diffuse lymph nodes and moderate hepatomegaly and splenomegaly. A blood count showed anemia, thrombocytopenia and leukocytosis (WBC 63x109/L] with 54% bla- sts. Laboratory findings were consistent with re- nal failure and high lactate dehydrogenase levels were observed. Peripheral blood smear shows large blasts with round nuclei, open chromatin and multiple nucleoli; their cytoplasm is deeply basophilic and contains numerous vacuoles.
Figure 32. Burkitt lymphoma. Bone marrow smear from the same case as Figure 31 showing hypercellularity with a monomorphic profile due to massive infiltration by blasts. Blast cells were negative for peroxidase and non-specific estera- se reactions, and showed a mature B-cell phe- notype. They were CD34 and TdT negative and expressed surface immunoglobulin, CD19, CD20, CD22 and CD79a. Cytogenetic analysis showed t(8;14)(q24;q32) with consequent deregulation of the MYC oncogene brought into close proximity to the Ig heavy chain region.
Figure 33. ur i lymphoma. Higher magni ca on of the same bone marrow smear as in Figure 32 reve- als blasts with nuclear and cytoplasmic features simi- lar to those observed in circula ng blasts. The cyto- logical, immunophenotypic and cytogene c ndings allowed the correct diagnosis to be made. Burki lymphoma is an aggressive lymphoma o en presen- ng at extranodal sites or as a leukemia, previously included in the French-American-Bri sh (FAB) classi- ca on L3 category of acute lymphoblas c leukemia. Nowadays, according to the recommenda ons of the World Health Organiza on, the leukemic presenta on of Burki lymphoma is not included among precursor lymphoid neoplasms since it has a mature B-cell im- munophenotype. In lymphomagenesis, Epstein-Barr virus represents a co-factor in endemic cases and in a signi cant por on of immunode ciency-related ca- ses, but is not associated with many sporadic cases.
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