Burkitt's lymphoma of the prostate presenting as acute urinary retention: a case report

Abstract

Background: Non-Hodgkin lymphomas, which include Burkitt's lymphoma, affect the prostate in only 0.1% of cases. They most commonly present as painless lymphadenopathy elsewhere in the body and can cause abdominal or thoracic pain and systemic symptoms such as fever, weight loss and night sweats. Here we report a rare case of sporadic Burkitt's lymphoma of the prostate whose initial clinical presentation was acute urinary retention.

Case presentation: A 28-year-old Caucasian male presented repeatedly with urinary retention. First, he was misdiagnosed with alcohol-induced urinary retention and later with benign prostatic hyperplasia. After the appearance of new symptoms, including hematuria and hydronephrosis, endoscopic and radiographic evaluation was performed. Transurethral biopsy of the prostate secured the diagnosis of Burkitt's lymphoma. The symptoms receded under chemotherapy and complete remission of the disease was established.

Conclusion: This case report brings lymphomas into focus as a differential diagnosis for urinary retention in young males. Early use of extensive diagnostic measures is advised in patients with urinary retention for uncertain reasons to make prompt diagnosis and start appropriate treatment early.

Keywords: Burkitt’s lymphoma of the prostate; Non-Hodgkin lymphoma of the prostate; Urinary retention.

Fig. 1

Histological and immunophenotypic features of prostatic Burkitt’s lymphoma. Microscopic observation of transurethral biopsy of the prostate and bladder neck. Homogeneously basophilic, poorly differentiated B-cells and scattered tingible body macrophages with pale cytoplasm creating the characteristic starry sky appearance a. Lymphoma cells are almost 100% Ki-67 positive b, show moderate CD10 expression c, atypical Bcl-2 positivity d and negative results for EBER e. a Haematoxylin and eosin stain (200x magnification) revealing tingible body macrophages (arrows). b Ki-67 reactivity (100x magnification). c CD10 reactivity (200x magnification). d Bcl-2 reactivity (400x magnification). e EBER in situ hybridization (400x magnification)

Fig. 2

FISH analyses of prostatic Burkitt’s lymphoma. Microscopic observation of transurethral biopsy of the prostate and bladder neck. a FISH for MYC. Break apart assay to detect breakpoints in the MYC gene, showing separation of the probes (red and green) on one allele (1000x magnification). b FISH for BCL6. The break apart assay shows no evidence of breakpoints in the BCL6 gene (1000x magnification). c FISH for t(8;14). Fusion assay confirming the typical translocation t(8;14) (1000x magnification)

Fig. 3

Radiographic extent of Burkitt’s lymphoma. Contrast enhanced staging CT scan after diagnosis of prostatic Burkitt’s lymphoma. a Axial view showing prostatic involvement and infiltration of the seminal vesicles (arrow). b Axial view showing involvement of paraaortic lymph nodes (arrow). c Coronal view showing bladder infiltration and gastric involvement (arrows). Ureteral stents and Foley catheter are visible

Fig. 4

Regression of prostatic Burkitt’s lymphoma during chemotherapy. Coronal view of contrast enhanced CT scan showing prostatic Burkitt’s lymphoma before (a), during (b) and after (c) chemotherapy. Burkitt’s lymphoma caused urinary retention and bilateral hydronephrosis. a Foley catheter and ureteral stents were inserted and chemotherapy started. b After one of 6 cycles significant downsizing of the lymphoma was seen. c Foley catheter and ureteral stents could be removed after 6 cycles of chemotherapy