An Exceptional Case of Simultaneous double ileoileal Intussusception Secondary to Burkitt’s Lymphoma

Intussusception is the telescoping or invagination of one segment of the bowel into its adjacent portion. It is common among children however it’s rare in adults, being seen in approximately only 5% of cases. In adults, it is the underlying cause of about 5% of bowel obstructions. More than half of these intussusceptions in adults are secondary to a neoplasm. Burkitt’s lymphoma is an uncommon cause of intussusception, in adults, less than 20 cases have been reported in the literature. Double intussusceptions due to Burkitt’s lymphoma are extremely rare. We present a case of a 20-year-old woman who presented symptoms of intestinal obstruction and was diagnosed with double ileoileal intussusception at Abdominal computed tomography and laparotomy exploration. The pathology of the lead points turned out to be Burkitt’s lymphoma. This case details a rare cause of intussusception secondary to Burkitt’s lymphoma. In infants, this is often treated with air enema reduction, but in adult populations, intussusceptions are normally associated with a lead point, therefore surgical management is essential. Hereby we present to you a second reported case in the literature of adult double intussusception due to Burkitt’s lymphoma. This report contains interesting diagnostic imaging, operative details, and specimen photographs.

The Primary Outbreaks of Burkitt Lymphoma in the Oral Cavity. A Report of Two Cases, Review of the Literature and Dental Implications

Two cases of Sporadic Burkitt’s lymphoma in children aged 11 and 8 years with primary symptoms in the oral cavity are reported. The first symptoms of the disease appeared in the oral cavity and were initially misdiagnosed as an inflammatory condition in one case and incidental findings not associated with the primary reason for visiting the dentist’s office in the second case. Biopsies of the lesions revealed the actual cause of the observed changes and contributed to the prompt initiation of polychemotherapy treatment. A review of current literature presents the known symptoms of Burkitt’s Lymphoma in the oral cavity and the available diagnostic methods. The role of the primary care physicians—the pedodontist and paediatrician—in the diagnostic and therapeutic process is discussed.

Primary Testicular Lymphoma a Rare Extra Nodal Involvement of NHL

Primary testicular lymphoma is a collection of neoplasms that constitutes only 1–9% of testicular tumors. Although uncommon in the general population, it is the most common type of malignant testicular tumor in men ≥50 years of age. There are various subtypes, including diffuse large B-cell lymphoma (DLBCL), Burkitt’s lymphoma and follicular lymphoma. In the adult testis, primary DLBCL represents the most frequent subtype of lymphoma (80–90%), whereas the majority of testicular lymphomas in children consist of secondary involvement by Burkitt’s lymphoma, DLBCL or lymphoblastic lymphoma. The typical clinical sign is a painless testicular mass of variable size that is usually unilateral. Primary testicular lymphoma may be identified during the initial presentation of primary or systemic malignant lymphomas, or during a clinical follow-up of patients with lymphoma. Historically, primary testicular lymphoma has been reported to exhibit a poor prognosis with an overall 5-year survival rate of 17–48%, particularly primary testicular DLBCL, whose clinical behavior has been reported to be aggressive and to demonstrate a high propensity to disseminate to the central nervous system (CNS) and skin at presentation and relapse. The underlying mechanisms responsible for this aggressive behaviour have yet to be elucidated. In the present study, a patient with primary testicular DLBCL was examined from histological examination and immunohistochemical staining in the diagnosis of testicular DLBCL.

Redox-modulation, Suppression of “Oncogenic” Superoxide and Induction of Apoptosis in Burkitt’s Lymphoma Cells Using Geum urbanum L. Extracts

Burkitt’s lymphoma is a highly aggressive type of non-Hodgkin’s lymphoma, linked to the Epstein-Barr virus, which induces oxidative stress and DNA damage in the infected cells. We investigated the cytotoxicity and redox-modulating ability of ethyl acetate (EtOAc) and n-butanol (n-BuOH) extracts from Geum urbanum L. roots and aerial parts on Burkitt`s lymphoma cells (BLC), to elucidate their impact on oxidative stress and cell survival. BLC Raji was treated with EtOAc and n-BuOH extracts to analyze: cell viability; induction of apoptosis; hydroperoxides and reactive nitrogen species (RNS) by 2’,7’-dichlorodihydrofluorescein assay; superoxide by dihydroethidium assay; total antioxidant capacity by TAC assay. All extracts suppressed cell growth and induce apoptosis. n-BuOH extracts possessed higher cytotoxicity and pro-apoptotic activity compared to EtOAc. The fractions decreased the hydroperoxides and RNS levels. There was no correlation between the DCF fluorescence in the treated cells and their viability (R = -0.3722; p > 0.05). Root extracts decreased the superoxide level, while the leaf extracts did not. There was a good correlation between the dihydroethidium fluorescence in the treated cells and their viability (R = 0.9843; p < 0.01). All extracts increased the TAC of BLC. G. urbanum extracts serve as redox-modulators and anti-inflammatory compounds, decreasing the intracellular level of “oncogenic” superoxide and cell proliferation.

Comparative Analysis of Mature T-Cell and NK/T-Cell Lymphomas in Patients with and without HIV: Results from the NA-Accord and Complete Cohorts

Background: Clinicopathological characteristics and prognosis for patients with HIV (PWH) and T-cell lymphomas (TCLs) in the current antiretroviral therapy (ART) era remains unknown. The primary objective of this study was to determine outcomes of patients with mature T and NK/T-cell lymphomas with and without HIV (PWoH) in North America. A secondary objective was to define variations in the survival of patients with TCLs and AIDS-defining B-cell lymphomas (A-BCLs) in the presence of ART. Methods: The study population included patients from two source populations, the NA-ACCORD (The North American AIDS Cohort Collaboration on Research and Design) and COMPLETE (Comprehensive Oncology Measures for Peripheral T-cell Lymphoma), both of which have been previously described. The NA-ACCORD collaborates with &gt;20 longitudinal cohorts of adults (aged ≥ 18 years) with HIV in the United States and Canada. Within the NA-ACCORD cohort, we included patients with a validated incidental diagnosis of mature T and NK/TCL (n=52) or the most common A-BCLs including Burkitt's lymphoma (n=101), diffuse large B-cell lymphoma (DLBCL, n=500) and primary CNS lymphoma (PCNSL, n=64) between 1996 and 2016. COMPLETE is a prospective, multicenter cohort study of patients with newly diagnosed incidental mature TCLs in the United States between 2010 and 2014. Of the 452 eligible patients, 450 were included for analysis after exclusion of two patients with HIV infection. Patients were followed from diagnosis to the first of death, loss to follow-up or administrative censoring at 5 years. Kaplan-Meier and log-rank tests were used to estimate and compare survival. Results: At the time of TCL diagnosis, PWH were significantly younger than patients without HIV (PWoH) (49 years vs. 60 years respectively; p&lt;0.001). PWH were predominantly men (96% vs. 63%; p&lt;0.001), of white race (64% vs. 77%; p&lt;0.006), with chronic kidney disease (19% vs. 2.2%; p&lt;0.001) and with co-infections such as hepatitis B virus (13% vs. 0.9%; p&lt;0.001) and hepatitis C virus (19% vs. 1.1%; p&lt;0.001). Anaplastic large-cell lymphoma (ALCL, n=26) was the most common histological subtype within PWH relative to peripheral T-cell lymphoma-not otherwise specified (PTCL-NOS, n=143) among PWoH. More than 92% of the patients within the NA-ACCORD cohort were on at least one class of ART during their cohort enrollment period. Median duration of ART prior to lymphoma diagnosis was 2.9 years (0.7-9.4) and comparable for patients with TCLs and A-BCLs. The median time from NA-ACCORD cohort enrollment to lymphoma diagnosis was 2.3 years (IQR: 0.3-5.9 years) for TCLs and comparable for patients with the A-BCL subgroups (2.8 years, IQR: 0.6-7.2 years; p=0.21). At the end of the 5-year follow-up period, the survival probability since TCL diagnosis was markedly lower at 0.32 (95% confidence interval [CI]: 0.21-0.49) among PWH in contrast to 0.45 (95% CI: 0.41-0.51) for PWoH. Specifically, survival probability since ALCL diagnosis was distinctively lower at 0.23 (95% CI: 0.11-0.47) among PWH in contrast to 0.76 (95% CI: 0.66-0.87) for PWoH. Mortality following lymphoma diagnosis was elevated for PWH vs. PWoH even after adjusting for statistically significant baseline clinical characteristics such as age, race, and ALCL status in multivariate analysis (adjusted HR: 1.92; 95% CI: 1.27, 2.91). Among PWH with TCL, CD4 &lt;200 and viral load (VL) &gt;500 (n=10) was associated with a lower survival relative to those with counts &gt;200 and/or VL &lt;500 (n=12, p=0.031). Upon stratification of PWH into different calendar periods based on year of diagnosis (1996-1999 vs. 2000-2009 vs. 2010-2016), we observed an improvement in survival for all subgroups over time. Overall, among PWH, PCNSL had the worst median overall survival (3.8 months, 95% Cl: 2.0-7.2 months) followed by ALCL (10.6 months, 95% Cl: 2.1-33.4 months), DLBCL (15.6 months, 95% CI: 12.7-22.2 months) and Burkitt's lymphoma. Conclusions: Our report based on two large observational cohorts in North America highlights poor outcomes for TCLs among PWH compared to PWoH. In addition, within the PWH group, our study is the first to delineate inferior survival for patients with ALCLs relative to DLBCL and Burkitt's lymphoma accentuating the need for novel therapies. However, the overall prognosis for these lymphomas among PWH has improved in the last two decades, particularly among those with CD4&gt;200, underscoring the impact of early and sustained ART. Disclosures Alonso: Merck: Research Funding. Foss: Kyowa: Honoraria; Acrotech: Honoraria, Speakers Bureau; Seattle Genetics: Honoraria, Speakers Bureau; Mallinckrodt: Honoraria; Daiichi Sankyo: Honoraria; Kura: Honoraria. Jain: Trillium Therapeutics, Inc: Research Funding; Acro Biotech, Inc: Research Funding; Abcuro, Inc: Research Funding.

BURKITT’S LYMPHOMA IN KIDNEY: A RARE ENTITY.

Burkitt’s Lymphoma is an aggressive form of Non-Hodgkin’s Lymphoma, with higher incidence in children comprising 30% of pediatric lymphoma. The hallmark of which is a translocation involving c-MYC gene on chromosome 8. Burkitt’s Lymphoma comprises of 6.35% of all lymphoma cases in Pakistan, with male predominance. Lymphoma rarely presents as a primary pathology of acute kidney injury. Burkitt’s lymphoma in adult population is uncommon and few cases have been reported where Burkitt’s lymphoma presents as a cause of acute kidney injury. There are three epidemiological subtypes Endemic (African), sporadic (non-endemic) and immunodeficiency related. Sporadic cases dominate amongst others in Pakistan.

Toward a methodology for evaluating DNA variants in nuclear families

The genetic underpinnings of most pediatric-cancer cases are unknown. Population-based studies use large sample sizes but have accounted for only a small proportion of the estimated heritability of pediatric cancers. Pedigree-based studies are infeasible for most human populations. One alternative is to collect genetic data from a single nuclear family and use inheritance patterns within the family to filter candidate variants. This approach can be applied to common and rare variants, including those that are private to a given family or to an affected individual. We evaluated this approach using genetic data from three nuclear families with 5, 4, and 7 children, respectively. Only one child in each nuclear family had been diagnosed with cancer, and neither parent had been affected. Diagnoses for the affected children were benign low-grade astrocytoma, Wilms tumor (stage 2), and Burkitt’s lymphoma, respectively. We used whole-genome sequencing to profile normal cells from each family member and a linked-read technology for genomic phasing. For initial variant filtering, we used global minor allele frequencies, deleteriousness scores, and functional-impact annotations. Next, we used genetic variation in the unaffected siblings as a guide to filter the remaining variants. As a way to evaluate our ability to detect variant(s) that may be relevant to disease status, the corresponding author blinded the primary author to affected status; the primary author then assigned a risk score to each child. Based on this evidence, the primary author predicted which child had been affected in each family. The primary author’s prediction was correct for the child who had been diagnosed with a Wilms tumor; the child with Burkitt’s lymphoma had the second-highest risk score among the seven children in that family. This study demonstrates a methodology for filtering and evaluating candidate genomic variants and genes within nuclear families that may merit further exploration.