Differential Diagnosis for Biopsy of a Mass
Single most likely diagnosis
- Burkitt lymphoma: This diagnosis is the most likely due to the description of uniform, round, medium-sized tumor cells with basophilic cytoplasm and a high rate of proliferation and apoptosis, which are characteristic features of Burkitt lymphoma. The "starry sky" appearance, although not mentioned, is often associated with this condition due to the numerous apoptotic cells and tingible body macrophages.
Other Likely diagnoses
- Diffuse large B-cell lymphoma (DLBCL): While DLBCL can have a variable appearance, some cases may show a high proliferation rate and apoptosis, making it a consideration in the differential diagnosis. However, the cells in DLBCL are typically more pleomorphic than those in Burkitt lymphoma.
- Mantle cell lymphoma: This lymphoma can also present with a high proliferation index, but the cells are usually smaller and have more irregular nuclear contours compared to Burkitt lymphoma.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Acute lymphoblastic leukemia (ALL): Although less likely given the description of a mass, ALL can present with similar cytological features, including a high rate of proliferation and apoptosis. Missing this diagnosis could lead to significant morbidity and mortality due to the aggressive nature of ALL.
- Aggressive T-cell lymphomas: Certain T-cell lymphomas, such as peripheral T-cell lymphoma or anaplastic large cell lymphoma, can have a high proliferation rate and may mimic the described features. These diagnoses are critical to consider due to their aggressive nature and different treatment approaches.
Rare diagnoses
- Blastic plasmacytoid dendritic cell neoplasm: This rare and aggressive tumor can present with similar features, including a high proliferation rate. However, it typically has distinct immunophenotypic characteristics that differentiate it from lymphoid neoplasms.
- Other high-grade lymphomas: Rare entities such as high-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements (double or triple hit lymphoma) could also be considered, although they are less common and might require additional diagnostic workup to distinguish from Burkitt lymphoma.