Question

Starry sky appearance is seen in -

• A. Burkitt lymphoma
• B. CLL
• C. Diffuse large B cell lymphoma
• D. ALCL

Hint:

Think of the fastest growing lymphoma with tingible body macrophages and c-MYC translocation.

Answer 1

The Correct Option is A

Step 1: The starry sky pattern is a low-power histological hallmark of Burkitt lymphoma. The tumour is a highly aggressive B cell neoplasm formed by a sheet of monotonous intermediate-sized lymphoid cells with round nuclei, coarse chromatin and several nucleoli.

Step 2: Burkitt lymphoma has a very high proliferation rate (Ki-67 near 100 percent) along with brisk apoptosis. The dying tumour cells are engulfed by numerous benign tissue macrophages scattered evenly among the dark tumour cells. These macrophages have abundant clear cytoplasm, so they appear as pale stars set against a dark blue background, producing the starry sky look.

Step 3: The genetic basis is a translocation of the c-MYC gene on chromosome 8, most often t(8;14) with the IgH locus, less often t(2;8) or t(8;22) with the light chain loci. Endemic (African) cases are linked with EBV.

Step 4: The distractors lack this pattern. CLL shows small mature lymphocytes with smudge cells, diffuse large B cell lymphoma shows large pleomorphic cells without an even macrophage scatter, and ALCL shows hallmark cells with horseshoe nuclei and ALK rearrangement. Hence the answer is Burkitt lymphoma.