A Case report of primary Burkitt's lymphoma of the caecum

A 13-year-old boy was admitted to our hospital complaining of right lower quadrant pain. Barium enema and total colonoscopy discloseed a type 2'tumor in the caecum, which was histopathologically a Burkitt's lymphoma by biopsy. Computed tomography (CT), ultrasonography and ⁶⁷Ga-scintigraphy demonstrated regional lymph node involvement. A right hemicolectomy with D_3+α lymph node dissection was performed. Histologically the tumor had a "starry sky" pattern, and immunophenotypical analysis showed that the neoplastic cells were CD10 antigen positive and CD21 antigen negative, suggesting of early B cell origin. Both immunoglobulin heavy chain and c-myc oncogene were found to be rearranged by southern blot analysis. On post-operative day 14, combined systemic chemotherapy (modified Japan Leukemia Study Group ALL-93 protocol) and intrathecal injection of MTX and Ara-C were given. There has been no sign of recurrence, as of 12 months after the surgery. The outcome of intestinal Burkitt's lymphoma is poor, because of frequency of a leukemic change or CNS relapse. Nonetheless, it was suggested that aggressive debulking of the tumor include an extensive resection of the lymphnodes (over D₃) and that intensive adjuvant chemotherapy may provide better prognosis in therapy to limit intestinal Burkitt's lymphoma.