# Burkitt Lymphoma

> Burkitt lymphoma for NEET-PG Medicine covers the t(8;14) MYC translocation, starry-sky histology, endemic and sporadic forms and tumour lysis risk.

- Canonical URL: https://prepelephant.com/topics/neet-pg/medicine/burkitt-lymphoma
- Exam / course: NEET-PG · Subject: Medicine
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-15
- Last updated: 2026-10-15
- Reference basis: Harrison's Principles of Internal Medicine; WHO Classification of Haematolymphoid Tumours
- How to cite: "Burkitt Lymphoma", PrepElephant, https://prepelephant.com/topics/neet-pg/medicine/burkitt-lymphoma

## Direct answer

Burkitt lymphoma is a highly aggressive mature B-cell non-Hodgkin lymphoma defined by a t(8;14) translocation that places the MYC oncogene beside an immunoglobulin gene. It shows starry-sky histology, with monotonous medium-sized cells and tingible body macrophages, and a very high proliferation index. Its rapid turnover carries a high risk of tumour lysis syndrome, so prophylaxis is started before treatment.

## What you must remember

- **Translocation:** t(8;14)(q24;q32) joins MYC with the immunoglobulin heavy chain locus, while the variant t(8;22) and t(2;8) involve light chain genes.
- **Histology:** a starry-sky pattern from tingible body macrophages within sheets of uniform cells, with a Ki-67 index often near 100 per cent.
- **Immunophenotype:** CD19, CD20 and CD10 positive, with surface immunoglobulin and BCL6 positivity, and typically Bcl-2 negative.
- **Endemic form:** jaw involvement in African children, strongly linked to Epstein-Barr virus.
- **Sporadic form:** abdominal disease, often ileocaecal, in children and adults in many regions, with a weaker link to Epstein-Barr virus.
- **Immunodeficiency form:** seen in HIV infection, with nodal and extranodal presentations in adults.
- **Tumour lysis:** hyperuricaemia, hyperkalaemia and hyperphosphataemia can follow rapid cell kill, so hydration and urate-lowering therapy start first.
- **Treatment:** short, dose-intensive chemotherapy suits the fast-growing tumour, with rituximab added for CD20-positive disease.

## Reading the form from the site and the virus

A 7-year-old child presents with a rapidly growing mass of the jaw, and the biopsy shows a starry-sky pattern. Growth over weeks rather than years is the clue that separates it from indolent lymphoma. The site and the Epstein-Barr virus status decide the form, but the histology and MYC rearrangement make the diagnosis.

| Feature | Endemic | Sporadic | Immunodeficiency-associated |
|---|---|---|---|
| Typical site | Jaw and facial bones | Abdomen, ileocaecal region | Nodal and extranodal |
| Age | Children | Children and adults | Adults |
| EBV link | Strong | Weaker | Frequent |
| Region | Equatorial Africa | Worldwide | Any region with HIV |

The three forms share the same MYC biology and the same urgency of treatment. Only the site and the virus link change, so the table is the quickest way to classify a case in the exam.

Staging should include bone marrow examination and assessment of central nervous system involvement by lumbar puncture, because the disease is often disseminated at presentation. Lysis labs are repeated during the first days of treatment, since the risk peaks early.

## Where the exam tries to catch you

Most lost marks come from confusing Burkitt lymphoma with indolent lymphomas or missing the lysis risk.

- **Trap:** Using Bcl-2 positivity to diagnose Burkitt lymphoma. — **Correct:** Burkitt is typically Bcl-2 negative, while follicular lymphoma with t(14;18) overexpresses Bcl-2.
- **Trap:** Starting chemotherapy without checking uric acid, potassium and phosphate. — **Correct:** Lysis risk is highest in the first days, so hydration, urate-lowering therapy and monitoring come before treatment.
- **Trap:** Treating a rapidly growing jaw mass in an African child as a dental infection. — **Correct:** Starry-sky histology with MYC rearrangement points to endemic Burkitt lymphoma, which needs urgent treatment.
- **Trap:** Expecting a slow response as in indolent lymphoma. — **Correct:** Burkitt is rapidly proliferating and very chemosensitive, so short, intensive regimens are used.

## Frequently asked questions

### Which translocation defines Burkitt lymphoma?

Burkitt lymphoma is defined by the t(8;14)(q24;q32) translocation, which places the MYC oncogene beside an immunoglobulin heavy chain gene. The variant translocations t(8;22) and t(2;8) involve immunoglobulin light chain genes instead.

### What is the starry-sky pattern in Burkitt lymphoma?

The starry-sky pattern is a sheet of uniform medium-sized lymphoma cells interspersed with tingible body macrophages, which resemble stars in the sky. It reflects a very high proliferation index and is a classic histological clue for Burkitt lymphoma.

### Why does Burkitt lymphoma cause tumour lysis syndrome?

Burkitt lymphoma cells turn over very rapidly, so chemotherapy releases large amounts of potassium, phosphate and uric acid in the first days of treatment. Hydration, urate-lowering therapy and close biochemical monitoring are therefore needed before therapy starts.

### How does endemic Burkitt lymphoma differ from sporadic Burkitt lymphoma?

Endemic Burkitt lymphoma in equatorial Africa typically involves the jaw in children and is strongly linked to Epstein-Barr virus. Sporadic Burkitt lymphoma more often involves the abdomen, such as the ileocaecal region, and has a weaker association with the virus.

### Which marker helps separate Burkitt lymphoma from follicular lymphoma?

Burkitt lymphoma is typically Bcl-2 negative, whereas follicular lymphoma with t(14;18) overexpresses Bcl-2. Burkitt lymphoma is also CD10 positive with a very high Ki-67 index, and MYC rearrangement testing confirms the diagnosis.