The Clinical Characteristics of Burkitt's Lymphoma seen in Kenyan Patients

Abstract

OBJECTIVE: To document the clinical features of Burkitt's lymphoma (BL) in the study population. DESIGN: Retrospective and prospective documentation of clinical details using a standard clinical assessment model. SETTING: Kenyatta National Hospital and all the seven provincial hospitals in Kenya. SUBJECTS: The study involved all cases with tissue proven diagnosis of Burkitt's lymphoma during the study period of ten years. MAIN OUTCOME MEASURES: For each BL case, the following were docummented age, sex, geographical (province) area, complaints, physical examination, investigation result findings. RESULTS: This study documented 961 children and 44 adults with Burkitt's lymphoma. Male to female ratio was 1.5:1 in children and 1:1 in adults. All the eight provinces in Kenya had cases of BL and of the 44 tribes 22 were represented. The study showed that BL is a rapidly growing tumour with peak duration of 4 weeks and main complaint was swelling. The major sites involved were Jaw 51.6%, abdomen 25%, combined jaw and abdomen 13.8% and other sites 9.6%. In adults, involved sites were jaw 4.5%, abdomen 43.2%, combined jaw and abdomen 25% and other sites 27.3%. CNS disease demonstrated in 39%, bone marrow 25% while abnormal liver function tests were 18% and abnormal kidney functions 20%. Involved sites in children, jaw peaked at three years 66.7% and abdomen at 14 years 66.7% while in adults abdominal presentation was dominant at all ages. Furthermore jaw were 55% males verses 16% females. Stage at presentation; A 35.2%. B 31.1%, C 31% and D 2.7%. Adult cases had stage D 75% and C 25% but no stage A and B. Adult cases showed HIV 59% positive, mostly over 25 and peaking at 34 years of age with 67.6% males and 42.4% females. HIV BL cases had disseminated disease with lymph nodes, scalp, bone marrow involvement and pancytopenia as major features. CONCLUSION: The clinical features are protean and BL is a rapidly progressive disease, presenting with swelling, majority in the jaw and abdomen in childhood and young adults. Age, sex and geographical (province) appear to influence the primary site of the disease. Also BL is a differential in many clinical presentations in this childhood setting.