Which histopathological feature best distinguishes Burkitt lymphoma from Diffuse Large B-cell Lymphoma (DLBCL)?

Question

Accepted Answer

D. Presence of t(8;14) translocation with MYC rearrangement. ## Distinguishing Burkitt Lymphoma from DLBCL

### Cytogenetic Hallmark

**Key Point:** The t(8;14)(q24;q32) translocation involving MYC and the immunoglobulin heavy chain (IGH) locus is the defining cytogenetic abnormality of Burkitt lymphoma and is virtually pathognomonic.

### Comparative Features

| Feature | Burkitt Lymphoma | DLBCL |
|---------|------------------|-------|
| **Cytogenetics** | t(8;14) MYC/IGH (95%) | Complex karyotype; MYC rearrangement rare (<10%) |
| **Cell size** | Medium, uniform cells | Large, heterogeneous cells |
| **Proliferation** | Ki-67 ~100% | Ki-67 30–90% |
| **Morphology** | Starry-sky pattern | Diffuse infiltration |
| **CD10 expression** | Positive (GCB type) | Variable |
| **Age** | Typically <40 years, often children | Older adults (median 60–70 years) |

### Why t(8;14) is the Gold Standard Discriminator

**High-Yield:** While both lymphomas are aggressive B-cell neoplasms with high proliferation rates and may show CD20+ phenotype, the **t(8;14) translocation is unique to Burkitt lymphoma**. This cytogenetic abnormality:

1. Juxtaposes the MYC oncogene to the IGH enhancer, causing constitutive MYC overexpression.
2. Is detected by karyotyping, FISH, or next-generation sequencing.
3. Is required for WHO diagnosis of Burkitt lymphoma.
4. Is absent in DLBCL (which may have other translocations like t(14;18) or complex patterns).

**Clinical Pearl:** Burkitt lymphoma is the most aggressive human malignancy but has excellent cure rates (>90%) with intensive chemotherapy (e.g., Hyper-CVAD) if diagnosed early. DLBCL has more heterogeneous outcomes depending on IPI score and molecular subtype.

### Why Other Features Are Not Discriminators

**Warning:** Both lymphomas express CD20, have high Ki-67, may involve extranodal sites, and can show starry-sky morphology — these are NOT specific to Burkitt. The starry-sky appearance (tingible body macrophages engulfing apoptotic debris) is seen in both but is more characteristic of Burkitt; however, it is not pathognomonic and can occur in other high-grade lymphomas.

Answer

A. Extranodal involvement with poor prognosis

Answer

B. CD20+ B-cell phenotype with high Ki-67 proliferation index

Answer

C. Starry-sky appearance with tingible body macrophages

Which histopathological feature best distinguishes Burkitt lymphoma from Diffuse Large B-cell Lymphoma (DLBCL)?

Explanation

Distinguishing Burkitt Lymphoma from DLBCL

Cytogenetic Hallmark

Comparative Features

Why t(8;14) is the Gold Standard Discriminator

Why Other Features Are Not Discriminators

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Feature	Burkitt Lymphoma	DLBCL
Cytogenetics	t(8;14) MYC/IGH (95%)	Complex karyotype; MYC rearrangement rare (<10%)
Cell size	Medium, uniform cells	Large, heterogeneous cells
Proliferation	Ki-67 ~100%	Ki-67 30–90%
Morphology	Starry-sky pattern	Diffuse infiltration
CD10 expression	Positive (GCB type)	Variable
Age	Typically <40 years, often children	Older adults (median 60–70 years)