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Long Bones

In younger children, Burkitt's tumors often involve the central diaphysis; in older children and adults, foci can be seen in the metaphysis. This pattern probably follows the distribution of the bone marrow, altering with age.

The long bones most frequently involved are the tibia, femur, humerus and clavicle, but even these are usually involved relatively late in the disease; rarely are pathological fractures or peripheral bone tumors the presenting findings. The pattern of bone involvement, wherever it may be, follows that already described in the jaw. As the confluent areas of osteolysis enlarge, a soft tissue tumor develops and spicules arise. Ultrasound and MRI can demonstrate the soft tissue components.

Angiography

There is little indication for angiography in most patients with Burkitt's lymphoma. The tumors, wherever located, are avascular but may stretch or displace adjacent vessels. There are no "new" vessels; the tumors do not blush, nor is there rapid venous drainage or other vascular abnormality. If ultrasound and CT (or MRI) are not available, angiography may help in the differentiation of renal disease, in the localization of cerebral tumors and, occasionally, in identifying liver or other abdominal masses. However, in most patients, the diagnosis is already established and the examination does not contribute to the patient's welfare. Bone tumors similarly show no abnormal vasculature. Fine-needle biopsy may be more useful.

Copyright: Palmer and Reeder