A rare cause of gallbladder perforation: Burkitt's lymphoma

Abstract

Although the perforation of gallbladder rarely occurs, it is a high-risk and life-threatening condition. High rates of mortality and morbidity are associated with late diagnosis. Burkitt’s lymphoma is a disease, which starts in B-cells and develops with leukemia and extranodal involvement. Involvement of gallbladder wall is a very rare location of extranodal lymphomas. In this case, a 68-year-old woman with severe pain in the left arm referred to our outpatients’ clinic where anti-HCV (+), leukocytosis, elevated sedimentation rate, and thrombocytopenia were found in her initial tests. On the basis of these findings, further tests were performed and she was diagnosed with Burkitt’s lymphoma. She had acute abdomen and  gallbladder perforation was detected by radiologic study. Urgent laparotomy was performed and she subsequently underwent cholecystectomy and drain insertion. Postoperative septic shock developed and she died due to multiple organ dysfunction syndrome. The determined diagnosis was described as gallbladder wall perforation associated with Burkitt’s lymphoma infiltration in the pathology report. It is very important for the clinicians to take into the consideration that a rare cause of gallbladder perforation is Burkitt’s lymphoma and it has an aggressive postoperative clinical course. 

Keywords

• Gallbladder perforation,Burkitt’s lymphoma

References

1. [1] Roslyn JJ, Thompson JE Jr, Darvin H, DenBesten L. Risk factors for gallbladder perforation. Am J Gastroenterol 1987;82:636-40.
2. [2] Menakuru SR, Kaman L, Behera A, Singh R, Katariya RN. Current management of gall bladder perforations. ANZ J Surg 2004;74:843-6.
3. [3] Derici H, Kara C, Bozdag AD, Nazli O, Tansug T, Akca E. Diagnosis and treatment of gallbladder perforation. World J Gastroenterol 2006;12:7832-6.
4. [4] Lennon F, Green WE. Perforation of the gallbladder. A review of 32 cases. J R Coll Surg Edinb 1983;28:169-73.
5. [5] Williams NF, Scobie TK. Perforation of the gallbladder: analysis of 19 cases. Can Med Assoc J 1976;115:1223-5.
6. [6] Niemeier O. Acute free perforation of the gallbladder. Ann Surg 1934;99:922-4.
7. [7] Alvi AR, Ajmal S, Saleem T. Acute free perforation of gall bladder encountered at initial presentation in 51 years old man: a case report. Cases J 2009;2:166.
8. [8] Sood BP, Kalra N, Gupta S, Sidhu R, Gulati M, Khandelwal N, et al. Role of sonography in the diagnosis of gallbladder perforation. J Clin Ultrasound 2002;30:270-4.

9. [9] Gruber PJ, Silverman RA, Gottesfeld S, Flaster E. Presence of fever and leukocytosis in acute cholecystitis. Ann Emerg Med 1996;28:273-7.
10. [10] Merriam LT, Kanaan SA, Dawes LG, Angelos P, Prystowsky JB, Rege RV, et al. Gangrenous cholecystitis: analysis of risk factors and experience with laparoscopic cholecystectomy. Surgery 1999;126:680- 6.
11. [11] Boerma EG, van Imhoff GW, Appel IM, Veeger NJ, Kluin PM, Kluin-Nelemans JC. Gender and age-related differences in Burkitt lymphoma--epidemiological and clinical data from The Netherlands. Eur J Cancer, 2004;40:2781-7.
12. [12] Blum KA, Lozanski G, Byrd JC. Adult Burkitt leukemia and lymphoma. Blood 2004;104:3009-20.
13. [13] Morton LM, Wang SS, Devesa SS, Hartge P, Weisenburger DD, Linet MS. Lymphoma incidence patterns by WHO subtype in the United States, 1992-2001. Blood 2006;107:265-76.
14. [14] Ziegler JL. Burkitt's lymphoma. N Engl J Med 1981;305:735-45.
15. [15] Ertem U, Duru F, Pamir A, Taçyildiz N, Dağdemir A, Akçayöz A, et al. Burkitt's lymphoma in 63 Turkish children diagnosed over a 10 year period. Pediatr Hematol Oncol 1996;13:123-34.
16. [16] Kutluk T, Varan A, Akyüz C, Büyükpamukçu M. Clinical characteristics and treatment results of LMB/LMT regimen in children with non-Hodgkin's lymphoma. Cancer Invest 2002;20:626-33.
17. [17] Cavdar AO, Yavuz G, Babacan E, Gözdasoglu S, Unal E, Ertem U, et al. Burkitt's lymphoma in Turkish children: clinical, viral [EBV] and molecular studies. Leuk Lymphoma 1994;14:323-30.
18. [18} Tüzüner N, Ince U, Yildiz I, Göçener S, Ulukutlu L. Small non-cleaved follicular center cell lymphoma in Turkey. Burkitt's and non-Burkitt's types. A retrospective clinicopathologic analysis of 53 cases in the pediatric age group. Cancer 1987;59:925-32.
19. [19] Ferry JA. Burkitt's lymphoma: clinicopathologic features and differential diagnosis. Oncologist 2006;11:375-83.
20. [20] Brooks JJ, Enterline HT. Primary gastric lymphomas. A clinicopathologic study of 58 cases with long-term follow-up and literature review. Cancer 1983;51:701-11.
21. [21] Wang SM, Huang FC, Wu CH, Ko SF, Lee SY, Hsiao CC. Ileocecal Burkitt's lymphoma presenting as ileocolic intussusception with appendiceal invagination and acute appendicitis. J Formos Med Assoc 2010;109:476-9.
22. [22] Allen CE, Kamdar KY, Bollard CM, Gross TG. Malignant non-Hodgkin lymphomas in children. In: Pizzo PA, Poplack DG, eds. Principles and Practice of Pediatric Oncology. 7th ed. Philadelphia Pa: Lippincott Williams & Wilkins; 2016:587-603.
23. [23] Balonga C, Lencina R, Reus M, Garre C, de las Heras M. [Burkitt's lymphoma: atypical localization]. Rev Esp Enferm Dig 1996;88:439-41. [Article in Spanish]
24. [24] Watson N, Cassibba V, Casini M, Mega A, Tauber M, Iori A, et al. Burkitt's Lymphoma of the stomach: a case report and review of the literature. J Blood Disord 2014;1:4.