Findings:

• Upper GI overhead film shows thickened gastric folds (esp. fundus), and thickened folds in jejunum.
• CT scan of the neck shows a large soft tissue mass in the nasopharynx.
• Bone scan demonstrates focal area of increased uptake in the proximal left femoral diaphysis as well as abnormal bowel activity in the right lower quadrant.
• Gallium scan (72 hour images, after a 24 hr bowel prep) shows diffuse uptake in the stomach, small bowel, nasopharynx, and faintly increased uptake in the proximal left femoral diaphysis.

Differential Diagnosis: Presented for thickened gastric folds which was the initial study performed at time of presentation and prior to biopsy: Infectious gastritis, Menetrier’s disease, lymphoma, eosinophilic gastritis, amyloidosis, pancreatitis.

Discussion: Non-Hodgkin’s lymphoma is the third most common malignancy in childhood and Burkitt’s lymphoma is the most common form of NHL, representing approximately 1/3 of these cases.

This is the most common form of Non-Hodgkin’s lymphoma in children and has been associated with the Epstein-Barr virus. Endemic population is in Africa (esp. areas with malaria). This is more common in children and young adults. In the endemic population the most common site of involvement is the jaw (usually, mandible). In the non-endemic population the most common site is the abdomen (seen in 90% of cases), especially involving the GI tract, with the terminal ileum and cecum being more commonly involved. The endemic form typically spreads to extranodal sites, e.g., bone marrow and meninges. The non-endemic form typically has skin, bone, peripheral node involvement at time of presentation. It also spreads to the CNS and bone marrow, although this is less frequent than in the endemic form. Ga-67 scintigraphy has reported 85% sensitivity for high grade NHL tumors with 100% sensitivity reported in Burkitt subtype. Baseline Ga-67 scan is helpful for follow-up imaging.

Burkitt’s lymphoma responds to chemotherapy with long term survival of 50%.

References:

1. Bloom DA, et al. Radiologic-Pathologic Conference of Children’s Hospital Boston:
   A palpable mass in an adolescent girl. Pediatric Radiology, Vol. 27, No. 11, pp. 888-891.

2. Hamrick-Turner JE, et al. Imaging of Childhood Non-Hodgkin Lymphoma: Assessment
   by Histologic Subtype. Radiographics. Vol. 14, No. 1, pp. 11-27.

3. Glass RBJ, et al. Gallium Scintigraphy in American Burkitt Lymphoma: Accurate
   Assessment of Tumor Load and Prognosis. American Journal of Radiology,
   Vol. 145, Oct. 1985, pp. 671-676.

   Return to Pediatric Imaging Page

   Submitted by:
   Puneet Singha, M.D.
   Melissa T. Myers, M.D.
   Rainbow Babies and Children's Hospital