Burkitt lymphoma masquerading as cardiac tamponade

A 61 year old man presented with diffuse large B cell lymphoma of the skin of the back of the shoulder which was excised and treated with chemotherapy (CHOP regime) in 1998. He was in complete remission till he presented in 2002 with extranodal marginal zone lymphoma of the parotid gland for which he underwent superficial parotidectomy and radiotherapy. He continued in remission till 2006 when he presented with recurrent pericardial effusion and tamponade. At median sternotomy, pericardial effusion was drained, an anterior pericardiectomy was done and a left posterior pericardial window made, and an enlarged hard paraaortic lymph node excised. Histology, immunocytochemistry and chromosome analysis revealed Burkitt lymphoma. Patient underwent chemotherapy with CODOX-M regime and continues in remission. This report is unusual on account of the highly atypical presentation of Burkitt lymphoma as cardiac tamponade, only a few cases having been reported previously, the occurrence of three lymphomas of different pathological and genomic profiles in one patient over a period of eight years and the relatively slow rate of growth of an otherwise fulminant tumour with high tumour doubling time. A review of literature with special emphasis on chromosomal diagnosis, transformation of other lymphomas into Burkitt lymphoma and mediastinal and cardiac involvement with Burkitt lymphoma is presented. Background Burkitt lymphoma is a type of B cell Non Hodgkin lymphoma which has endemic (African) and non-endemic (American) sub-divisions. An aggressive tumour involving mostly abdomen, jaw, head, neck and peripheral lymph node sites, it has a tumour doubling time of only 24 hrs. Involvement of mediastinal lymph nodes is extremely rare and there are only isolated instances of presentation with cardiac tamponade. To our knowledge, there are no reports of a delayed transformation of a large diffuse B cell lymphoma or a marginal zone parotid lymphoma into a Burkitt lymphoma after a long period of remission. Case Presentation A 61 year old male underwent excision of diffuse large B cell lymphoma of the skin over left shoulder in 1998 which was treated with CHOP chemotherapy including Prednisolone. He stayed in remission till 2002 when he presented with a painless swelling of the preauricular region arising from the parotid gland for which he underwent superficial parotidectomy. The histology revealed extra-nodal marginal zone lymphoma of parotid salivary gland. The immunohistochemistry revealed a composite phenotype: CD20+, CD5-, CD10-, bcl 6-, bcl 1-, bcl 2+, bcl 10-, p53+/-, p21+/-, CD79a+. There was no evidence of the previous diffuse large B cell lymphoma. Radiotherapy was given to left parotid area over 3 weeks in 15 fracPublished: 5 July 2007 Journal of Cardiothoracic Surgery 2007, 2:30 doi:10.1186/1749-8090-2-30 Received: 15 November 2006 Accepted: 5 July 2007 This article is available from: http://www.cardiothoracicsurgery.org/content/2/1/30 © 2007 Kaul and Javangula; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.