Leukemic phase of Burkitt lymphoma

摘要

A 47-year-old male with headaches for 2 months developed slurred speech. Physical examination showed a large, 7-cm left neck mass and splenomegaly. Complete blood count revealed leukocytosis (33.3 X 10~9/L), normocytic anemia (11.5 g/dL), and thrombocytopenia (20 X 10~9/L). The peripheral smear (panels A and B) revealed markedly decreased platelets, mild anisocytosis, multiple blasts (38 percent), some with vacuoles, and prominent nucleoli and occasional folded nuclei. The bone marrow biopsy showed diffuse infiltration by medium-sized blasts with high Ki-67/MIB, compatible with Burkitt lymphoma (BL). A diagnosis of leukemic phase of BL was made. The neurologic symptoms prompted brain imaging that was negative. However, a lumbar puncture showed the presence of lymphoid cells with the same characteristics as the malignant lymphoma. Finally, HIV testing was positive.