Adult intussusception is an infrequent occurrence typically resulting from an identifiable lead point of a benign or malignant etiology. Here, we present a case of a 19-year-old male who presented to the emergency department with complaints of abdominal pain, intractable nausea, and fluctuations between bloody diarrhea and constipation. These symptoms had begun two months prior and had increased in severity, resulting in significant appetite changes. An abdominal and pelvic computed tomography scan without contrast was obtained, which showed evidence of intussusception of the ileocecum into the transverse colon with resultant small bowel obstruction. The patient underwent an exploratory laparotomy, which resulted in a partial ileocolectomy due to the presence of a 6.8 cm cecal mass with palpable mesenteric lymphadenopathy. The pathologic specimen was identified as Burkitt lymphoma based on a combination of histologic, immunohistochemical, and fluorescence in situ hybridization findings. Currently, the patient is undergoing three cycles of rituximab, cyclophosphamide, vincristine, doxorubicin, high-dose methotrexate, ifosfamide, etoposide, and high-dose cytarabine (R-CODOX-M/IVAC) per Magrath protocol for low-risk Burkitt lymphoma.

Burkitt lymphoma (BL) is a neoplasm of the lymphoid tissue and one of the most prevalent malignancies worldwide. Classically, these patients present with unregulated B-cell differentiation causing fever, chills, night sweats, and weight loss. Although more common in children, in sporadic Burkitt lymphoma, symptoms often can be present in the abdomen. These patients also additionally report nausea, vomiting, and abdominal distention, which in rare instances can cause small bowel obstruction (SBO). Early detection and the initiation of chemotherapy remain highly effective in providing adequate care. This provides better outcomes and prevents surgical management.

The presentation of Burkitt lymphoma (BL) is variable and highly dependent on its subtype. It often presents with non-specific symptoms and may appear in the jaw, bone marrow, liver, spleen, kidneys, ovaries, and gastrointestinal tract. This case describes a 50-year-old male who presented with abdominal pain and was eventually found to have Burkitt lymphoma, diagnosed by biopsy of a cecal polyp. Herein, we explore the diagnostic journey to BL and review the literature regarding its unique manifestations and thus the diagnostic challenge it can present.

Non-Hodgkin lymphoma is made from the B-cell lineage and includes extra-nodal marginal lymphomas, follicular lymphomas, mantle cell lymphoma, diffuse large B-cell lymphoma, and Burkitt lymphoma. Burkitt lymphoma is associated with Epstein Barr Virus and Human Immunodeficiency Virus. Although it is common for other B-cell lymphomas to develop in the stomach, it is less common for Burkitt lymphoma tumors to manifest there. Additionally, primary and/or secondary involvement of the duodenum, pancreas, and intestines is very rare in Burkitt lymphoma. Herein, we present a male diagnosed with extensive Burkitt lymphoma of the bone, lymph nodes, pancreas, small intestine, duodenum, and stomach.

To characterize modified R-CODOX-M/IVAC-based chemotherapy to lower the severe adverse events in Chinese adult patients with sporadic Burkitt lymphoma.
We enrolled a retrospective cohort including 123 adult patients with untreated sporadic Burkitt lymphoma from August 2008 to September 2019 at Sun Yat-sen University Cancer Center. We studied a dose-modified and long-course R-CODOX-M/IVAC regimen utilizing a low dose of 1.0 g/m2/cycle cyclophosphamide, 2 g/m2/cycle methotrexate, 4,500 mg/m2/cycle ifosfamide, and 4.0 g/m2/cycle cytarabine. Forty-nine patients with low risk disease underwent 4-6 cycles of dose-modified R-CODOX-M-based chemotherapy. Seventy-four patients with high risk disease underwent 6-8 cycles of dose-modified alternating R-CODOX-M/IVAC regimens.
The objective remission was 87.0%. The event-free survival rate and overall survival at 3 years were 81.2% and 92.1%, respectively. Major grade 3-4 adverse events included leukopenia (91.9%), anemia (58.5%), thrombocytopenia (73.2%), and febrile neutropenia (48.8%). A total of 26.0% and 37.4% of patients received red blood cell and platelet transfusions, respectively. We observed 4 cases (3.3%) of septic shock after chemotherapy. Two treatment-related deaths occurred from severe infection.
The modified R-CODOX-M/IVAC chemotherapy regimen was effective for sporadic Burkitt lymphoma in the Chinese population, with a lower toxicity than standard regimens.

Burkitt lymphoma (BL) is an aggressive form of lymphoma that occurs due to translocation of the c-myc proto-oncogene on chromosome 8. BL is characterized by three distinct groups: African/endemic variant, immunosuppressive variant, or sporadic variant. Most cases of the sporadic variant occur in patients less than 40 years of age with a median age of 30 at diagnosis and are primarily seen in Caucasians. An immunocompetent 69-year-old male presented with subacute onset weakness in the lower extremities. Magnetic resonance imaging (MRI) of the lumbar spine revealed a mass in the right paraspinal musculature with epidural extension, neural foraminal narrowing, and severe spinal canal stenosis in L2-L5. MRI of the thoracic spine revealed significant T5-T6 cord compression due to metastatic masses. Further diagnostic imaging revealed diffuse lymphadenopathy within the mediastinum and abdomen. Subsequently, the patient underwent a core needle biopsy of the left axillary lymph node, which revealed cluster of differentiation 20 and 10 (CD20 and CD10), c-myc, and B-cell lymphoma 6 (Bcl-6) positive lymphoid cells. A diagnosis of BL was made. The patient was treated with oral steroids and received one round of radiation therapy. The patient opted to forgo any antitumor treatment and was discharged to hospice. Primary lymphomas of the central nervous system (CNS) account for <5% of all CNS tumors. Approximately 5-10% of CNS lymphomas are recorded as BL, with the majority classified as high-grade B-cell lymphomas. Paraspinal involvement with BL is rare and not commonly seen in the sporadic variant.

BACKGROUND: Adult sporadic Burkitt lymphoma (BL) is a rare but highly aggressive subtype of lymphoma which lacks its own unique prognostic model. Systemic inflammatory biomarkers have been confirmed as prognostic markers in several types of malignancy. Our objective was to explore the predictive value of pretreatment inflammatory biomarkers and establish a novel, clinically applicable prognostic index for adult patients with sporadic BL.
METHODS: We surveyed retrospectively 336 adult patients with newly diagnosed sporadic BL at 8 Chinese medical centers and divided into training cohort (n = 229) and validation cohort (n = 107). The pretreatment inflammatory biomarkers were calculated for optimal cut-off value. The association between serum biomarkers and overall survival (OS) was analyzed by Kaplan-Meier curves and Cox proportional models. The risk stratification was defined based on normal LDH level, Ann Arbor stage of I and completely resected abdominal lesion or single extra-abdominal mass < 10 cm.
CONCLUSIONS: Univariate and multivariate analyses revealed that platelets< 254 × 109/L, albumin< 40 g/L, lactate dehydrogenase≥334 U/L independently predicted unfavorable OS. We used these data as the basis for the prognostic index, in which patients were stratified into Group 1 (no or one risk factor), Group 2 (two risk factors), or Group 3 (three risk factors), which were associated with 5-year OS rates of 88.1, 72.4, and 45%, respectively. In the subgroup analysis for high-risk patients, our prognostic model results showed that high-risk patients with no more than one adverse factor presented a 5-year survival rate of 85.9%, but patients with three adverse factors had a 5-year survival rate of 43.0%. Harrell\'s concordance index (C-index) of the risk group score was 0.768. Therefore, the new prognostic model could be used to develop risk-adapted treatment approaches for adult sporadic BL.

BACKGROUND: Acute small bowel obstruction is a common surgical emergency usually caused by abdominal adhesions, followed by intraluminal tumors from metastatic disease. Although lymphomas have been known to cause bowel obstruction, Burkitt lymphoma is seldom reported to induce an obstruction in the adult population.
METHODS: A 78-year-old Hispanic man with a history of abdominal interventions presented to our hospital with abdominal pain. Computed tomography revealed a partial small bowel obstruction attributed to local inflammation or adhesions. Medical management with bowel rest and nasogastric decompression resulted in resolution of symptoms and quick discharge. He returned 2 days later with worsening abdominal pain. Repeat imaging showed progression of the partial small bowel obstruction, but with an additional 1.6-cm nodular density abutting the anterior aspect of the gastric antrum and lobulated anterior gastric antral wall thickening. He was taken to the operating room, where several masses were found. Intraoperative frozen sections were consistent with lymphoma, and pathology later revealed Burkitt lymphoma. Disease was found on both sides of the diaphragm by positron emission tomography. After the initial resection and adjuvant chemotherapy, the patient is alive and well about 14 months after resection.
CONCLUSIONS: Small bowel obstruction is uncommonly due to Burkitt lymphoma in the geriatric population and is more frequently seen in the pediatric and young adult populations. Burkitt lymphoma is very aggressive with rapid cell turnover leading to significant morbidity. The rapid recurrence of an acute abdominal process should prompt an investigation for a more sinister cause such as malignancy.

OBJECTIVE: Sporadic Burkitt lymphoma is rarely associated with orbital involvement.
METHODS: We present a case of sporadic Burkitt lymphoma with extramedullary subperiosteal leukemic infiltrates of the orbit and facial bones.
RESULTS: Follow-up examination after chemotherapy and disease remission reveals resolution of the subperiosteal infiltrates.
CONCLUSIONS: Despite an aggressive presentation, cure is common with appropriate, intensive treatment. To our knowledge, this report is the first to photographically depict the resolution of extramedullary orbital subperiosteal leukemic infiltrates after appropriate chemotherapy.