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The doughnut sign: an ultrasound finding in pediatric intestinal Burkitt's lymphoma
T Hasegawa1, J Sumimura, S Mizutani
1Division of Pediatric Surgery, Kinan General Hospital, Tanabe City, Wakayama, Japan.
Insights
The ultrasound "doughnut sign" can help diagnose pediatric intestinal Burkitt's lymphoma. This finding, characterized by a thickened, layered ring, was observed in a young boy with this rare cancer.
Area of Science:
- Pediatric Oncology
- Abdominal Imaging
- Gastrointestinal Pathology
Background:
- Burkitt's lymphoma is an aggressive non-Hodgkin lymphoma that can affect the gastrointestinal tract in children.
- Early and accurate diagnosis is crucial for effective treatment and improved outcomes.
- Imaging plays a vital role in the initial detection and characterization of pediatric abdominal masses.
Observation:
- A case study involving a 9-year-old boy presenting with a large abdominal mass.
- Ultrasound (US) revealed a distinctive doughnut-like appearance of the affected intestinal segment.
- The US findings included a thickened, layered ring with specific echo characteristics suggesting mucosal, muscular, and intraluminal components.
Findings:
- The characteristic doughnut sign on ultrasound correlated with diffuse thickening of the intestinal wall in Burkitt's lymphoma.
- High serum lactic dehydrogenase levels were noted, a common marker in lymphoma.
- Surgical exploration confirmed a large jejunal tumor consistent with Burkitt's lymphoma.
Implications:
- The ultrasound "doughnut sign" may serve as a valuable, non-invasive diagnostic clue for pediatric intestinal Burkitt's lymphoma.
- This imaging finding can potentially aid in differentiating Burkitt's lymphoma from other pediatric abdominal pathologies.
- Further research could validate the utility of the doughnut sign in larger pediatric cohorts.
Abstract:
This paper describes a doughnut-like ultrasound (US) finding in pediatric intestinal Burkitt's lymphoma. A 9-year-old boy had a fist-sized, hard, non-movable mass in the lower abdomen. US showed a thickened, layered ring like a doughnut. The outer, low-level echoes seemed to be consistent with mucosa and muscle layers and the inner, high-level echoes seemed to be intraluminal air or mucus. The serum lactic dehydrogenase level was high. At surgery, a solid, hard tumor 15 x 10 cm in size was found in the jejunum. The intestinal wall was diffusely thickened with an intact mucosa. From this experience, the US doughnut sign may be a helpful diagnostic finding in pediatric intestinal Burkitt's lymphoma.
