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Primary Burkitt Lymphoma of the Chest Wall

DOI: 10.1155/2012/746098

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Abstract:

Burkitt lymphoma (BL) originating in the skin and soft tissue at any site is exceedingly rare. This paper is about a case of primary sporadic BL that presented as an isolated, rapidly enlarging chest wall mass arising from skin and/or soft tissue in an adult. As with other BL presentations, this patient was treated with aggressive chemotherapy with central nervous system (CNS) chemoprophylaxis, but he later died because of sepsis. 1. Introduction Chest wall tumors are a heterogeneous group of benign and malignant disorders. Burkitt lymphoma (BL) originating in the skin and soft tissue at any site is exceedingly rare. This paper illustrates a case of primary sporadic BL that presented as an isolated, rapidly enlarging chest wall mass arising from skin and/or soft tissue in an adult and provides an overview of the clinicopathologic features of skin and soft tissue lymphomas including BL. 2. Case Report A 33-year-old previously healthy man presented with one-month history of a painful red nodule over his left chest wall. He initially noticed a discomfort in the area after chopping wood and later found a small “pimple-like” nonpustular nodule in the same area. After a week, the lesion became larger, erythematous, and painful. At an outside hospital, he underwent an incision and drainage of the chest wall mass without histological examination for a presumed diagnosis of chest wall abscess. Several days after drainage, a similar nodule recurred at the incised area, which rapidly grew in size. He also reportedly started experiencing fever and chills and was readmitted to the same hospital for a diagnosis of necrotizing chest wall infection. A debridement with excisional biopsy of the chest wall revealed atypical lymphoid cells, prompting transfer to our institution. Upon transfer, a large, gaping, erythematous, and indurated wound with indistinct, thickened borders and extensive edema and necrosis of subcutaneous tissue and musculature of almost the entire left chest wall was noted. No palpable peripheral lymphadenopathy or organomegaly was observed. The serum lactate dehydrogenase (LDH) and uric acid levels at baseline were elevated at 1113?U/L (reference range: 336–610) and 9.2?mg/dL (reference range: 3.5–7.5), respectively, while his renal function was normal. The complete blood count (CBC) was significant for mild normocytic, normochromic anemia with hemoglobin of 11.0?g/dL. In our institution, he underwent debridement and partial excision of the chest wall wound with biopsy. The histopathology revealed atypical lymphocytes with prominent nucleoli and

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