Imaging: — Bulky mass often with central necrosis in region of right lower quadrant or terminal ileum — Mass has mesenteric vessel encasement and bowel wall thickening and may cause intussusception — Aneurysmal dilation of the affected bowel with asymmetric wall thickening — Sandwich sign – bowel loops sandwiched between mesenteric masses — Also see lesions in breast, liver, spleen, kidney, ovary, lymph nodes, mandible
DDX:
Complications: Most common cause of intussusception in child greater than 4 years old
Treatment:
Clinical: — Peak age 5 years — Most common form of non-Hodgkin lymphoma in children less than 15 years old — Most common malignancy to involve mesentery and omentum — Can present with large soft tissue mass — Common in Africa
Radiology Cases of Burkitt Lymphoma
Coronal T1 MRI without contrast of the abdomen (upper left) shows bilateral enlarged kidneys which after the administration of contrast (upper right) is seen to be due to multiple non-enhancing renal masses. Transverse US of the liver (below) shows a round hypoechoic mass in the liver, superior and to the left of the gall bladder.Axial (above), coronal (lower left) and sagittal (lower right) CT with contrast of the abdomen shows multiple dilated loops of small bowel and a soft tissue mass in the right upper quadrant just beneath the gall bladder that shows the target sign on the sagittal image and the pseudokidney sign on the transverse and coronal images. The soft tissue mass was still present on an US performed 1 hour later.Axial CT with contrast of the abdomen (above) shows a round soft tissue mass on the left side of the pelvis that has a target sign appearance. Coronal (below left) and sagittal (below right) CT show multiple large mesenteric lymph nodes and that the soft tissue mass arises in the pelvis and also has a pseudokidney sign appearance.
Surgery Cases of Burkitt Lymphoma
Laparoscopic surgical image (above) shows the small bowel-small bowel intussusception. Surgical image of the small bowel after reduction of the intussusception (below) shows the serosa is pink-tan and intact with a 1.5 x 0.6 cm puckered, red, firm area that when opened in pathology revealed a 2.6 x 2.0 cm red-pink mass.
Surgical image obtained after intussusception reduction and resection of the intussusception’s pathological lead point shows multiple large mesenteric lymph nodes.
Gross Pathology Cases of Burkitt Lymphoma
Gross pathological images of the resected segment of intussuscepted small bowel shows on its serosal surface (above) a 2.0 x 1.2 cm irregular, tan-white centrally ulcerated and umbilicated firm area. The opened image of small bowel (below) reveals a 3.4 x 2.9 x 1.2 cm irregular, tan-white, smooth, firm mass which was sectioned to reveal smooth, tan-white, glistening, homogenous cut surfaces.
