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We describe a case of Burkitt’s lymphoma (BL) of the small intestine diagnosed on ultrasound-guided fine needle aspiration cytology (FNAC). BL is a high-grade lymphoma usually involving the mandible and the intestines. An early diagnosis is paramount for prompt and effective management. FNAC forms a rapid and effective tool towards an early detection of these lymphomas. A 5-year-old boy presented with abdominal discomfort and progressively increasing abdominal mass. The computed tomography (CT) scan revealed markedly thickened bowel loops with multiple enlarged lymph nodes. There were well-defined hypoechoic nodular lesions in both the kidneys. A suspicion of lymphomatous origin was raised. Ultrasound-guided FNAC was performed through the thickened bowel. Smears were stained with Giemsa and Papanicolaou stains. Many monomorphic, round to oval single cells were identified. These cells displayed a high nucleo-cytoplasmic ratio, vesicular chromatin and prominent cytoplasmic vacuolization [Figure 1]. Many lymphoglandular bodies were seen scattered in the background. A cytological diagnosis of BL of the small intestine was made. The patient was put on a chemotherapeutic regimen, which resulted in the regression of the abdominal mass.
The small intestine is a common site of BL in children and is associated with multisystem lesions. Abdominal mass, bone marrow and central nervous system involvement are poor prognostic markers. Total tumor burden is the principal determinant of prognosis. FNAC, along with other ancillary techniques, provides a rapid and simple tool for early diagnosis and treatment. Ogawa et al. used FNAC as a primary tool in the diagnosis of BL of bilateral breasts. Das et al. studied 40 cases of BL and found the intra-abdominal location as a common location in Indian patients. FNAC under guidance can help in a rapid diagnosis, thereby assisting in an early treatment in these high-grade lesions.
The author would sincerely like to thank Dr. Aparna Ahuja, Dr. Simi Bhatia and the Executive Director, Dr. Amar Dasgupta, for their constant support and guidance.