Transcription
Médicos is perfection. Alice once again today. Let's talk about Burkitt's lymphoma diagnosis and treatment.
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As you know from the previous video, Burkitt's lymphoma affects young males. 30% of children with non-Hodgkins have Burkitt's lymphoma. It's one of the AIDS-defining malignancies in sub-Saharan Africa, associated with Epstein-Barr virus. There could be bone marrow involvement, leading to a leukemic phase. c-MEK proto-oncogene amplification due to the 8;14 translocation. There is an American subtype and an African subtype. And Burkitt's is the most rapidly progressive human tumor ever. So, do you suspect that we will treat it with watch and wait or chemotherapy? Of course, the answer is chemo. This is aggressive. This is the most rapidly progressing tumor.
Diagnosis of Burkitt's lymphoma: you need a thorough history and physical exam. Excisional biopsy. Immune phenotyping because this is a B-cell lymphoma. You'll have a GMC 10, HLA-DR, CD4, T3, and B-cell markers such as CD19, CD20, and 22. There is extremely high proliferation fraction, also known as high mitotic index, which makes sense because Burkitt's lymphoma is the most rapidly progressive tumor ever. You need CBC, blood chemistry such as LDH (will be high), uric acid level (will be higher due to the rapid proliferation). HIV testing is needed because Burkitt's is associated with decreased immunity. Staging by physical exam and CT scan. If there's site opinion, do a bone marrow biopsy. PET scan can help with diagnosis and follow-up. By the way, high mitotic index can differentiate between Burkitt's lymphoma, which has a high mitotic index, and diffuse large B-cell lymphoma, which has a not so high mitotic index.
God, the lymph node biopsy! What did you see? Starry sky. What is the star? Reactive histiocyte. What is the sky? A background of neoplastic B-cells. The macrophage is the star. As you know, non-Hodgkins lymphoma is aggressive and indolent. We treat the aggressive using chemotherapy. Since Burkitt's is an aggressive lymphoma, we'll treat it using chemotherapy. In aggressive lymphomas, patients are younger with more B symptoms. They are sensitive to chemo. The median survival rate is short.
Let's talk about non-Hodgkins lymphoma and pregnancy. If you have a diagnosis of non-Hodgkins lymphoma during the first trimester, you should terminate and give chemo. If you have a diagnosis in the second and third trimester, you give chemo using the CHOP regimen: cyclophosphamide, doxorubicin, vincristine, prednisone.
Treatment of Burkitt's: since Burkitt's is the most rapidly progressive tumor, you should start treatment promptly, during the first 48 hours after diagnosis. Time is crucial. Time equals life or death here. If the initial treatment fails, salvage therapy will be futile, useless. What is salvage therapy? Salvage therapy is chemotherapy for the second time after the first time has failed. In Burkitt's lymphoma, only the initial treatment is your hope. Salvage therapy doesn't work, which emphasizes the importance of the initial therapy. What's the initial therapy? Intensive combination chemotherapy with any combination that includes cyclophosphamide. Symptomatic treatment for tumor lysis syndrome by fluid and allopurinol. Tumor lysis syndrome will have high potassium, phosphate, uric acid, and low calcium because phosphate binds calcium and precipitates calcium. CNS prophylaxis because chemotherapy cannot adequately pass the blood-brain barrier, so you need intrathecal treatment done.
That's it for today. Thank you so much for watching. Don't forget to subscribe and share my videos with others. Thank you. Médicos is perfection. Endless.