Very aggressive lymphomas

Burkitt lymphoma: Pan-B markers, Ig+, Ki67 >99% favours BL (cf DLBCL <90%). 80% t(8;14)(q24;q32), 15% t(2;8)(q11;q24), 5% t(8;22)(q24;q11) juxtapose c-MYC with Ig gene loci and cause MYC overexpression but this is not diagnostically useful as expressed in normal cells and other lymphomas. Endemic cases have raised antibody titres to EBV antigens and multiple copies of EBV DNA in the tumour (unusual in sporadic cases).

Precursor B-lymphoblastic: Pan-B markers, Ig-, CD10+, TdT+. Precursor T-lymphoblastic: Pan-T markers, TdT+. Staging investigations

• Histological diagnosis by expert haematopathologist: biopsy of lymph node or extranodal mass with immunophenotyping ± molecular analysis.

• Detailed history and physical examination including Waldeyer's ring

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