[Burkitt's lymphoma diagnosed by molecular analysis of DNA from malignant cells in ascites]

A 73-year-old man was admitted with severe abdominal fullness. Physical examination suggested much ascites. Laboratory data revealed that BUN was 39 mg/dl, Cr was 2.2 mg/dl, UA was 19.7 mg/dl, and LDH was 1,569 U/l. In ascites, there were many cells with large nuclei and many vacuoles. Immunocytological characterization indicated that most of these cells were B lineage. And diagnosis of malignant lymphoma, the patient was treated with VEPA therapy. However, he soon died with acute renal failure. We examined the possibility of gene rearrangements between the c-myc and immunoglobulin genes and found that c-myc gene was rearranged at the first intron, and joined with immunoglobulin JH locus as head to head. These results suggested that the patient carried Burkitt's lymphoma of the American type.