Non-Endemic Burkitt's Lymphoma: A B-Cell Tumor Related to Germinal Centers

To investigate the nature of non-endemic Burkitt's lymphoma, we examined neoplastic cells from eight American patients for receptors for sheep erythrocytes (E), complement (EAC), and Fc fragment of IgG (IgGEA), and for surface immunoglobulins (Slg) and hydrolytic enzymes. In addition, we reviewed 47 biopsies and 17 autopsies from American patients to ascertain patterns of involvement by tumor in lymph nodes, spleens and Peyer's patches. Neoplastic cells in all cases studied bore monoclonal surface immunoglobulins of the IgM class. Receptors for EAC and IgGEA were identified on a minority of the cells. Little or no hydrolytic enzyme activity was demonstrable. These results indicate that, like Burkitt's lymphoma in Africans, this histologically identical tumor in American patients consists of B lymphocytes. In 10 biopsies and two autopsies, germinal centers were selectively involved by tumor, suggesting that these neoplastic cells may be related to some B lymphocytes of normal germinal centers. (N Engl J Med 295:685†691, 1976). urkitt's lymphoma has distinctive clinical and pathological features. Although endemic in tropical Africa1Burkitt's lymphoma occurs in many countries, including the United States.2African and non-endemic cases are histologically identical but clinically somewhat different. Differences include presenting sites of tumor, age at onset and frequency of late relapse after chemotherapy.3In addition, although there is a strong association between Epstein†Barr virus and Burkitt's lymphoma in African patients, based on serum antibody titers and DNA homology studies4with few exceptions this relation has not been found in American cases.5Neoplastic cells from numerous African but few American cases have been studied. © 1976, Massachusetts Medical Society. All rights reserved.