An unusual care of burkitt lymphoma of terminal ileum with concomitant metastatic renal cell carcinoma

SESSION TITLE: Critical Care Case Report Posters 68 SESSION TYPE: Case Report Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm INTRODUCTION: Burkitt lymphoma is an aggressive type of B-cell high-grade Non-Hodgkin lymphoma that is most common in children. It presents as three different forms which are sporadic, endemic EBV-associated and immunodeficiency-associated. Sporadic Burkitt lymphoma is typically located in the abdomen or pelvis. This cancer is caused by t(8;14) leading to increased expression of c-myc oncogene. Due to its aggressive nature, it is treated with high grade systemic chemotherapy given over a short period of time and treatment may include central nervous system prophylaxis with intrathecal chemotherapy. With prompt treatment, Burkitt lymphoma is considered a curable disease. The reported cases of rare presentations of Burkitt lymphoma include as bilateral renal Burkitt lymphoma and primary renal Burkitt lymphoma. There was one case reported of Burkitt lymphoma of the ileum in remission with subsequent development of non-metastatic renal cell carcinoma, but to the best of our knowledge this is the first case reported of sporadic Burkitt lymphoma of the terminal ileum with concomitant metastatic renal cell clear cell carcinoma in an adult patient presenting with septic shock. CASE PRESENTATION: A 40-year-old male with past medical history of high-grade sporadic Burkitt lymphoma of the terminal ileum treated with chemotherapy hyper-CVAD (cyclophosphamide, vincristine, adriamycin and dexamethasone), R-HD-MTX/ARA-C (rituximab, high-dose methotrexate and cytarabine) presented with right sided flank pain and admitted to ICU for septic shock. He was placed on pressors and empiric antibiotics. Urine cultures were positive for E. coli. CT abdomen and pelvis with contrast showed a 4.1 cm x 3.4 cm endophytic, heterogeneously enhancing mass in the superior aspect of the right kidney through the collecting system just inferior to the adrenal gland. CTA chest showed a 10 mm right upper lung nodule. MRI abdomen with and without contrast was significant for a heterogeneously enhancing complex mass in the upper pole of the right kidney which measured 2.9 x 3.4 x 3.4 cm. A CT-guided renal mass biopsy showed polygonal cells with a clear lipid-filled cytoplasm diagnostic of clear cell type renal cell carcinoma. Lung nodule biopsy confirmed metastatic renal cell carcinoma to the lung. DISCUSSION: We present a case of metastatic clear cell renal cell carcinoma and septic shock that developed in a patient with sporadic Burkitt lymphoma. RCC is the most common renal malignancy in adults. Risk factors are smoking, hypertension, occupational exposures, Von Hippel-Lindau and chronic hepatitis C infection; all which were negative in this patient. The subtype clear cell accounts for approximately 70-80% of the cases. It is usually diagnosed incidentally since most patients are asymptomatic but in some cases it can present with flank pain. There has not been a clear association with Burkitt lymphoma and the concomitant development of Renal cell carcinoma, but this case brings to our attention that the development of renal malignancies with subsequent complications should be considered in these patients and requires further research. CONCLUSIONS: In conclusion, consideration of concomitant malignancies such as Burkitt lymphoma and Renal cell carcinoma, although rare, can occur and further research is needed for prompt diagnosis and treatment to prevent mortality. REFERENCE #1: Atkins, M. B., Bakouny, Z., & Choueiri, T. K. (2023, March 3). Epidemiology, pathology, and pathogenesis of renal cell carcinoma. UpToDate. Retrieved March 5, 2023, from https://www.uptodate.com/contents/epidemiology-pathology-and-pathogenesis-of-renal-cell-carcinoma?search=clear+cell+renal+cell+carcinoma&source=search_result&selectedTitle=3~37&usage_type=default&display_rank=3#H17 REFERENCE #2: Freedman, A. S., & Aster, J. C. (2021, July 29). Epidemiology, clinical manifestations, pathologic features, and diagnosis of Burkitt lymphoma. UpToDate. Retrieved March 5, 2023, from https://www.uptodate.com/contents/epidemiology-clinical-manifestations-pathologic-features-and-diagnosis-of-burkitt-lymphoma?search=burkitt+lymphoma&source=search_result&selectedTitle=1~82&usage_type=default&display_rank=1 REFERENCE #3: David AW, Indrani S, Apurva S, Sukria N, Benjamin P. Burkitt's lymphoma of the ileum with renal cell carcinoma. Can J Surg. 2008 Aug;51(4):E77-8. PMID: 18815632; PMCID: PMC2552925. DISCLOSURES: No relevant relationships by Shaun Isaac No relevant relationships by Kristina Menchaca No relevant relationships by Catherine Ostos No relevant relationships by Virginia Velez Quinones