Kapitančukė Monika, Vaščiūnaitė Agnija, Augustinienė Rasa, Sakalinskienė Jūratė, Kleinotienė Gražina
Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Department of Radiology, Children's Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.
Acta Med Litu. 2018;25(1):23-30. doi: 10.6001/actamedica.v25i1.3700.
Primary tumours of the gastrointestinal tract are very uncommon in children. They can present with anaemia caused by gastrointestinal acute or chronic bleeding. One of the most common gastrointestinal tumours is Burkitt lymphoma. This lymphoma is a highly aggressive, rapidly growing B-cell neoplasm, making survival without treatment possible only for a few weeks. For this reason it requires immediate hospitalization and treatment.
We report a case of a gastric Burkitt lymphoma in an adolescent girl who presented with anaemia due to gastrointestinal bleeding. She received out-patient care with iron medications orally due to suspected iron-deficiency anaemia but there was no sufficient effect. The patient was referred to Children's Oncohematology Department with a progression of symptoms (weakness, fatigue, sound in the ears, and nausea) five months after anaemia was diagnosed in the complete blood count. The imaging tests showed a massive solid tumour with bleeding in the stomach. The final diagnosis was a histologically atypical Burkitt lymphoma. Chemotherapy treatment was started according to NHL-BFM 2004 paediatric protocol.
Non-Hodgin's lymphoma is the most common malignancy of the gastrointestinal tract in children and about 75% of these tumours are Burkitt lymphomas. They can present with anaemia in the complete blood count due to bleeding. Reticulocyte test and serum ferritin level test help to differentiate pathophysiological origin of anaemia. Combination chemotherapy according to standardized protocols is the best current standard of care and has a very good clinical response without unfavourable risk factors.
胃肠道原发性肿瘤在儿童中非常罕见。它们可因胃肠道急性或慢性出血而导致贫血。最常见的胃肠道肿瘤之一是伯基特淋巴瘤。这种淋巴瘤是一种高度侵袭性、快速生长的B细胞肿瘤，若不治疗，生存期仅为数周。因此，它需要立即住院治疗。
我们报告一例青春期女孩的胃伯基特淋巴瘤，该患者因胃肠道出血出现贫血。由于怀疑缺铁性贫血，她接受了口服铁剂的门诊治疗，但效果不佳。在全血细胞计数诊断出贫血五个月后，患者因症状进展（虚弱、疲劳、耳鸣和恶心）被转诊至儿童肿瘤血液科。影像学检查显示胃内有一个巨大的实性肿瘤并伴有出血。最终诊断为组织学非典型伯基特淋巴瘤。根据NHL-BFM 2004儿科方案开始化疗。
非霍奇金淋巴瘤是儿童胃肠道最常见的恶性肿瘤，其中约75%为伯基特淋巴瘤。它们可因出血导致全血细胞计数出现贫血。网织红细胞检测和血清铁蛋白水平检测有助于区分贫血的病理生理起源。根据标准化方案进行联合化疗是目前最佳的治疗标准，且在无不利风险因素的情况下临床反应良好。
