Introduction Burkitt's lymphoma was originally described in 1958 by Burkitt, a surgeon working in Uganda. It was first noted in African children and presented as a jaw or facial mass. Today it is more commonly seen in the Western world as abdominal disease presenting in children, young adults, and HIV-positive patients. Burkitt's lymphoma is known to be associated with the Epstein-Barr virus. It is also associated with a nonrandom chromosome translocation, which results in deregulation of the c-myc oncogene. Burkitt's lymphoma has been documented in other extranodal sites but only in a few cases has it been described in the heart. We present a case of Burkitt's lymphoma diagnosed by right atrial heart biopsy.
Case Report A 68-year-old Caucasian female with COPD and type 2 diabetes mellitus presented to the hospital after recently being treated at an outside facility for a lower GI bleed. Upon questioning, this patient also reported a 3-month history of fatigue, chills, night sweats, and progressive dyspnea on exertion. She had undergone a colonoscopy with biopsies at the outside facility and path specimens obtained during the procedure were suggestive of Burkitt's lymphoma. She was transferred to our hospital for further evaluation. Physical exam on admission was benign except for scattered wheezes bilaterally on examination of the lungs. Laboratory studies revealed anemia with a hematocrit of 30.6 with an MCV of 91.8 and an RDW of 15.3. The remainder of the CBC, chemistry, liver panel, and coagulation studies were within normal limits. Staging CTs were obtained, which were unremarkable except for a filling defect noted in the right atrium of the heart. Follow-up cardiac MRI revealed a fungating mass in the right atrium. Interventional cardiology was consulted, and they performed a biopsy of the mass. Pathology confirmed the presence of Burkitt's lymphoma in the heart mass, the morphology of which was identical to the pathology seen on colon biopsy. The patient was started on chemotherapy consisting of Cytoxan, Adriamycin, and etoposide, as well as allopurinol. She tolerated the treatment well and was discharged home.
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