Your pathology report for Burkitt lymphoma

by Rosemarie Tremblay-LeMay MD FRCPC
September 10, 2025

Burkitt lymphoma is a rapidly growing cancer of the immune system that originates from B cells, a type of white blood cell that normally helps fight infections. This lymphoma is unique because it is almost always associated with a genetic mutation in the MYC gene, which causes the cancer cells to divide rapidly.

Due to this rapid growth, Burkitt lymphoma often presents as a large tumour at the time of diagnosis and can spread to multiple parts of the body.

Where in the body is Burkitt lymphoma found?

Burkitt lymphoma can affect many different organs. It often develops outside of lymph nodes, which makes it different from many other types of lymphoma. Common sites include:

  • The bones of the face, especially the jaw.

  • The long bones of the arms and legs.

  • The gastrointestinal tract (stomach or intestines).

  • The gonads (testes or ovaries).

  • The kidneys and breasts.

It can also spread to the brain and spinal cord, and in some cases, cancer cells can be found circulating in the blood.

What type of lymphoma is Burkitt lymphoma?

Lymphomas are divided into two main groups: Hodgkin lymphoma and non-Hodgkin lymphoma (NHL). Burkitt lymphoma is a type of non-Hodgkin lymphoma.

What are the types of Burkitt lymphoma?

Doctors describe three clinical subtypes of Burkitt lymphoma, based on where and in whom the disease develops:

  • Endemic subtype: Found in areas where malaria is common, especially in Africa. It primarily affects children and often involves the jaw or facial bones.

  • Sporadic subtype: Found worldwide, most often in children and young adults. It typically involves the abdomen, including the intestines.

  • Immunodeficiency-associated subtype: Found in people with weakened immune systems, especially those with human immunodeficiency virus (HIV).

Some cases, especially the endemic subtype, are also associated with Epstein–Barr virus (EBV) infection.

How do pathologists make the diagnosis?

The diagnosis of Burkitt lymphoma is usually made after a biopsy, where a small piece of the tumour is removed and examined under the microscope.

Because this cancer grows so quickly, the tumour may already be quite large at the time of diagnosis. Pathologists use a combination of microscopic features and special tests to confirm the diagnosis.

What does Burkitt lymphoma look like under the microscope?

When viewed under the microscope, Burkitt lymphoma has several distinctive features:

  • The tumour is composed of medium-sized B cells that all appear very similar to one another.

  • There are many mitotic figures, which are cells actively dividing.

  • There are also many apoptotic bodies, which are the remains of dying cancer cells.

  • These dead cells are cleared away by immune cells called macrophages. The pale macrophages scattered among the dark cancer cells give the tissue a “starry sky” appearance, which is a classic feature of Burkitt lymphoma.

What other tests are performed to confirm the diagnosis?

Because other lymphomas can resemble Burkitt lymphoma, additional tests are necessary to confirm the diagnosis.

Immunohistochemistry

This test uses antibodies to highlight proteins inside the cancer cells.

In Burkitt lymphoma, the cancer cells show the following features:

  • They are positive for B-cell proteins such as CD20, PAX5, and CD79a.

  • They are positive for proteins characteristic of germinal centre B cells, such as CD10 and BCL6.

  • They are positive for MYC, the protein produced by the abnormal MYC gene.

  • They are negative for proteins such as CD5, CD23, and BCL2, which helps separate Burkitt lymphoma from other types of B-cell lymphoma.

Pathologists also use immunohistochemistry to measure how quickly the cells are dividing. This is called the proliferation index. In Burkitt lymphoma, nearly every cell is dividing, so the proliferation index, measured by Ki-67 (MIB1), is typically close to 100%.

Molecular tests

Burkitt lymphoma is characterized by a genetic alteration known as a translocation that involves the MYC gene. A translocation happens when a piece of one chromosome breaks off and attaches to another chromosome.

This rearrangement places the MYC gene under the control of other active DNA sequences, causing the cancer cell to produce excessive amounts of MYC protein. MYC drives the cells to divide rapidly, leading to the aggressive nature of this lymphoma.

Pathologists usually test for MYC translocations using a technique called fluorescence in situ hybridization (FISH). This test can be performed on biopsy tissue and is used to confirm the diagnosis of Burkitt lymphoma.

What is the prognosis for Burkitt lymphoma?

With modern treatment, the prognosis for Burkitt lymphoma is excellent, especially when the disease is diagnosed quickly and treated without delay.

In countries with access to advanced medical care and medicines, including chemotherapy and the antibody drug rituximab, survival rates are excellent:

  • More than 90% of children are cured.

  • About 80% of adults survive long-term.

Doctors now use a scoring system called the Burkitt Lymphoma International Prognostic Index (BL-IPI) to help estimate the outlook. It places patients into three risk groups:

  • Low risk: About 96% survive.

  • Intermediate risk: Approximately 76% of patients survive.

  • High risk: Approximately 59% of patients survive.

Patients with HIV-associated Burkitt lymphoma also respond well to similar treatments, showing that this disease can often be controlled even when the immune system is weakened.

In countries with fewer resources, outcomes are generally less favourable. This is partly due to limited access to accurate diagnosis and timely treatment. Delays in recognizing the disease also contribute. Survival rates have improved in recent years as more intensive regimens and advanced cancer care systems have been introduced. However, Burkitt lymphoma still places a significant burden on healthcare in these regions.

Questions to ask your doctor

  • Was a MYC translocation confirmed in my tumour?

  • Which subtype of Burkitt lymphoma do I have?

  • Has the cancer spread to my brain, spinal cord, or blood?

  • What treatment options are available for me?

  • How quickly do I need to start treatment, given how fast this cancer grows?

  • Will my treatment plan include chemotherapy, immunotherapy, or other targeted therapies?

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