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Diagnosis of Burkitt lymphoma using an algorithmic approach--applicable in both resource-poor and resource-rich
Kikkeri N Naresh1, Hazem A H Ibrahim, Stefano Lazzi
1Department of Histopathology, Hammersmith Hospital Campus, Imperial College, London, UKDepartment of Human Pathology and Oncology, University of Siena, Siena, ItalyUniv Paris-Sud, F-94270, Le Kremlin-Bicêtre; AP-HP, Hôpital Bicêtre, Service d'Hématologie et Immunologie Biologiques, Cytogénétique, F-94270, Le Kremlin Bicêtre, FranceDepartment of Haematology, Hammersmith Hospital Campus, Imperial College, London, UKSaint Mary Hospital, Lacor, Gulu, UgandaUniversity of NairobiNairobi HospitalAga Khan University Hospital, Nairobi, KenyaMuhimbili National HospitalMuhimbili University of Health and Allied Sciences, Dar Es Salam, TanzaniaInternational Network for Cancer Treatment and Research, Brussels, BelgiumDepartment of Histopathology, Faculty of Medicine, Mansoura University, Egypt.
Abstract:
Distinguishing Burkitt lymphoma (BL) from B cell lymphoma, unclassifiable with features intermediate between diffuse large B-cell lymphoma (DLBCL) and BL (DLBCL/BL), and DLBCL is challenging. We propose an immunohistochemistry and fluorescent in situ hybridization (FISH) based scoring system that is employed in three phases - Phase 1 (morphology with CD10 and BCL2 immunostains), Phase 2 (CD38, CD44 and Ki-67 immunostains) and Phase 3 (FISH on paraffin sections for MYC, BCL2, BCL6 and immunoglobulin family genes). The system was evaluated on 252 aggressive B-cell lymphomas from Europe and from sub-Saharan Africa. Using the algorithm, we determined a specific diagnosis of BL or not-BL in 82%, 92% and 95% cases at Phases 1, 2 and 3, respectively. In 3·4% cases, the algorithm was not completely applicable due to technical reasons. Overall, this approach led to a specific diagnosis of BL in 122 cases and to a specific diagnosis of either DLBCL or DLBCL/BL in 94% of cases that were not diagnosed as BL. We also evaluated the scoring system on 27 cases of BL confirmed on gene expression/microRNA expression profiling. Phase 1 of our scoring system led to a diagnosis of BL in 100% of these cases.
