1. POEM Group Online Case Discussion Date: April 1, 2014
1 New Case:
CD022: Burkett's Lymphoma (Egypt)

2. POEM Group Online Case Discussion
Date:01/04/2014
Case # 1: CD022 O.M.A

3. Case # 1: Referred by Physician: Referring Hospital:
Patient Initials : O.M.A
Nationality: Egyptian
Gender: male
DOB: Age: 14
Diagnosis: Burkett's lymphoma
Date of Diagnosis: 02/02/2014
First Consultation / Follow Up

4. Disease History
14 years old, boy, with left knee mass for which he underwent 3 surgeries in the past 4 years
Only In the last operation, the pathology was reviewed ( National Cancer institute ) suggesting malignancy.
So he was referred to NCI for further investigation

5. Initial Imaging Work up outside NCI :
05/09/2013: MRI lt. knee : acute osteomyelitis with cystic swelling of abscesses
29/12/2013 : CT angiography of the abdominal Aorta and both lower limb arteries was normal
12/02/2014 : Pathology read as high grade lymphoma
20/02/2014 : IHC was positive for CD 99 and CD45

6. Work up at NCI :
25/02/2014 : BM biopsy and CSF were negative
23/02/2014 : Pathology : tumor cells diffusely +ve for LCA and focally +ve for CD99 , viable tumor cell +ve for CD20 & -ve for CD3 &CD10 , Ki-67 LI is about 100%
24/02/2014 : CT of head , chest ,abdomen and pelvis was normal
03/03/2014 : Bone scan showed lesion at the distal 1/3 of left femur with no evidence of skip lesion or distant bone metastasis

7. Treatment Protocol
Patient started on the LMB protocol in 19/03/2014 and for re- evaluation at D8 post induction
Due for F/U imaging at D8 post induction.

8. Questions What are the DD for B.lymphoma of bone primary site
Although no sign of metastasis , the pt. considered as group B , concerning the micro-mets. When we can grad a pt. as group
What we should consider in the evaluation beside the response for the induction