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Laboratory Diagnosis

In the acute phase of the disease there will be marked elevation of the C-reactive protein, ceruloplasmin, and haptoglobin. Phase-contrast examination of cells from the tumors, from ascitic, pleural and cerebrospinal fluid, and from bone marrow or spleen is an accurate diagnostic aid. The cells are twice the diameter of lymphocytes, and are noncoherent, spherical, dark, opaque, and nonmotile. There are usually a few superficial lipid granules at one pole or in a broad band around the cell's equator: the nucleus occupies most of the cell, is pale, and shows large bizarre nucleoli. It is easy to distinguish this cell from those of neuroblastoma, rhinoblastoma, and Wilm's tumor. The Burkitt cell is also distinctive on culture and may be easily maintained. Because of the very different prognosis it is important that there be an accurate histological diagnosis, and it has recommended by Edington (from Ibadan) that, in addition to normal histological examination, there should always be:

1. A press or imprint preparation of the tumor on slides, fixed in methyl alcohol and stained with May-Grünwald or Jenner-Giemsa stains

2. A suspension of cells in tissue culture 119 medium for phase contrast

3. Cell culture

This combination will almost certainly allow an accurate diagnosis in all cases. Electron microscopy will show a high cytoplasmic content of RNA, using pyronin and acridine orange staining; this is a useful histological feature which will help to separate Burkitt's lymphoma from other malignant lymphomas. There should never be rosettes, pseudorosettes, or neurofibrils in Burkitt's tumor, in contradistinction to their common appearance in neuroblastoma. The peripheral blood is normal and leukemic changes are extremely rare. There may be an increase in protein in the cerebrospinal fluid, which is otherwise normal. The serum lactate dehydrogenase (LDH) is often raised, and falls with successful chemotherapy. If the tumor recurs, the LDH rises again. Apart from this, there are no significant changes in blood chemistry. A positive reaction can be obtained if the correct immunological serum is available. (The molecular translocations are also important.)

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