The abdominal sonographic features of burkitt's lymphoma in patients seen at Uganda Cancer Institute, Mulago Hospital, Kampala
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INTRODUCTION: Burkitt lymohoma is a B-cell lymphoma presenting in three main clinical variants: the endemic, the sporadic and the immunodeficiency-associated variants. In Uganda, Burkitt’s lymphoma represents 50-70% of childhood cancers presenting mainly as facial tumour. Diagnosis depends on tissue examination. Imaging provides very useful diagnostic and staging information. Characteristically abdominal BL sonographically presents as well defined solid hypoechoic mass with mass effect; they lack calcifications and are a vascular on colour Doppler study. Ultrasound therefore plays an important auxiliary role in early detection and diagnosis of this potentially curable tumour and can be used to predict the prognosis. OBJECTIVES: The major objective of the study was to describe the sonographic features of BL and to relate them with the clinical features and laboratory findings in order to determine the prognostic benefit of abdominal ultrasound in patients with BL at the UCI-Mulago hospital. METHODOLOGY: This case series was conducted In UCI and Department of Radiology-Mulago hospital from march 2009 to September 2009. Sixty (60) patients with confirmed BL had abdominal ultrasonography done before initiation of chemotherapy and at one month after initiation of chemotherapy. RESULTS: Sixty (60) patients participated in the study. The age range was 3-18 years with a mean of 7.2 and standard deviation of 2.98. The peak incidence was between 5-9 years. There were 43 (71.7%) males and 17(28.3%) females. Facial bone tumours remained the commonest clinical finding however, the commonest single presenting compalit was palpable abdominal mass with pain in 31(51.7%) patients. Abdominal ultrasound showed that 40 (66.7%) of all patients had intra abdominal masses. Forty four (73.3%) patients had the tumours involving other parts of the body. Mpst patients presented with stage D disease and therefore had poor prognosis. The commonest ultrasound findings were multiple lobulated heterogeneous hypoechoic abdominal masses in 40 (66.7%) patients. Of these masses 20(33.3%) were in the kidneys. Follow-up abdominal ultrasound showed that 32(80%) patients had tumour regression after one month of induction. CONCLUSION: • Abdominal ultrasound was able to demonstrate greater disease extent than clinical evaluation, thus highlighting the value of imaging in tumour staging and follow-up of patients. • This study showed more cases of abdominal BL involvement than previously seen in our patients, possibly due to better imaging facilities now. • Burkitt’s lymphoma should be strongly suspected in a child presenting with large lobulated hypoechoic intra-abdominal mass and histological diagnosis must be established as soon as possible. • Serum LDH levels were very high in patients with large and multiple tumour sites involvement but decreased as the tumour mass regressed. RECOMMENDATIONS: • Follow up abdominal ultrasound should be done after one month of treatment in order to assess early response to chemotherapy. • A bigger study should be done to comprehensively assess the role of ultrasound and serum LDH levels in follow up and determination of prognosis in BL patients.