Analysis of the Diagnosis of Burkitt-Like Lymphoma in a Patient With Atypical Cytogenetics and Molecular Markers

The World Health Organization (WHO) criteria for diagnosis of hematopoietic and lymphoid cancers serve as a useful t­ool for distinguishing between malignant conditions based on phenotypic, morphologic, and/or cytogenetic presentations, but their utility is limited in patients whose diseases contain elements of multiple diagnoses. We present a case of a 59-year-old male with enlargement of muscular and soft tissues of the left hip and an intraconal soft tissue mass surrounding the left optic nerve, who was treated for Burkitt-like lymphoma (BLL). Cytogenetics revealed the absence of an MYC rearrangement involving chromosomes 2, 14, or 22, normally found in Burkitt lymphoma, or the classic telomeric losses and proximal gains observed in BLL. Diffuse large B-cell lymphoma, not otherwise specified (DLBCL, NOS) and high-grade B-cell lymphoma, not otherwise specified (HGBL, NOS) were also considered as possible diagnoses. The persistence of ambiguous lymphoma diagnoses demonstrates the need for both continued research in the area and regular revision of the WHO criteria. Physicians working with patients with poorly defined lymphomas should defer to diagnostic algorithms where applicable, many of which have been proposed in the literature.