Question:

Which of the following statements regarding surgical management of Burkitt lymphoma is true?
1. All Burkitt tumors should be surgically resected.
2. Surgical mortality of untreated Burkitt lymphoma is low.
3. Small Burkitt tumors should be exclusively managed with chemotherapy.
4. The goal of surgery in abdominal Burkitt lymphoma is for total excision of the tumor burden.
5. Overaggressive surgical management can lead to poor outcomes.





Answer:

The correct answer for the question "Which of the following statements regarding surgical management of Burkitt lymphoma is true?" is:

5. Overaggressive surgical management can lead to poor outcomes.



Explanation
A. Not all Burkitt tumors require aggressive surgical debulking.  [The utility of early tumor resection in children with extensive intra-abdominal Burkitt lymphoma, even in the setting of bowel obstruction, should be questioned.]

B. Aggressive surgical measures for untreated Burkitt lymphoma is associated with high mortality.  [Gahukamle et al found that the mortality after emergency laparotomy in the setting of untreated Burkitt lymphoma was very high and was not improved by aggressive tumor resection.]

C. Surgery may be indicated in cases of small tumors.  [Patients with small tumors that are localized and can be safely resected may benefit from complete surgical resection.]

D. The goal of surgery is for safe, accurate diagnosis.  [Except in rare instances in which a solitary lesion lends itself to total or near-total resection (i.e. at least 90% of the tumor can be resected), the proper role of surgery is a simple, safe procedure to obtain enough viable tumor for accurate diagnosis and prompt chemotherapy.]

E. Overaggressive surgery could be fatal.  [Furthermore, overly aggressive surgery may contribute to increased mortality.]



From the manuscript:
Presentation of Ileal Burkitt Lymphoma in Children
Radiology Case. 2012 Aug; 6(8):27-38


This article belongs to the GI section.




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From the manuscript

Presentation of Ileal Burkitt Lymphoma in Children

Free full text article: Presentation of Ileal Burkitt Lymphoma in Children

Abstract
Burkitt lymphoma is a highly aggressive form of Non-Hodgkin lymphoma that responds favorably if diagnosed accurately and treated early. Recognition of the various radiologic manifestations of Burkitt lymphoma can help guide the clinician to expedite appropriate chemotherapy. We present two cases that illustrate different radiologic presentations of this aggressive gastrointestinal malignancy in children. Case 1 features a 7-year-old boy who presented to our hospital with recurrent ileocecal intussusception. Case 2 describes a 16-year-old male with history of blood-streaked stools. Ileocectomy was performed in both cases and histologic analysis showed the "starry sky pattern" and t(8;14) translocation, classic for Burkitt lymphoma. Both patients remain disease-free following surgical excision and chemotherapy.






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