• RAFIL TOMA YAQO Assist. Professor, Pathology Department, College of Medicine, University of Duhok, Duhok, Kurdistan Region of Iraq.
Keywords: Burkitt’s lymphoma, EBER, EBV, IRAQ, MYC



Background: Burkitt's lymphoma (BL) is the most common lymphoma in children and primarily, but certainly not exclusively, originates in the lymphoid tissue of the distal ileum. This study looks at the Epstein-Barr virus latency and C-MYC gene rearrangement in tumor cells from patients in Iraq's Duhok province.

Methods: Between 2014 and 2020, archived surgical pathology tissue from thirty Kurdish patients diagnosed with BL in the Duhok region of northern Iraq was examined. Formalin-fixed, paraffin-embedded (FFPE) tissue blocks were used to make tissue microarrays (TMA), which were then studied using immunohistochemistry for a panel of lymphoma markers, in-situ hybridization (ISH) for EBV-encoded RNAs (EBER1), and fluorescent in-situ hybridization (FISH) for C-MYC/IGH translocation.

Results: The median age of patients was 7 years (3-22). Twenty-two were male and eight were female. Twenty-five patients had extra-nodal primaries, 21 of them had intrabdominal primaries, the ileocecal region accounted for all of the cases, and five had nodal primaries. All patients had c-MYC rearrangement in their tumors, whereas EBER1 was present in 22 (73%) of the tumors.

Conclusion: This study reveals that Burkitt lymphoma in the Duhok region is a juvenile illness with a preference for the ileocecal region, as opposed to the United States and northern Europe, where it is regarded as an adult disease with a propensity for the lymph nodes.


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1. Basso K, Dalla-Favera R. Germinal centres and B cell lymphomagenesis. Nat. Rev. Immunol 2015; 15:172-184.
2. Brady G, MacArthur GJ, Farrell PJ. Epstein-Barr virus and Burkitt’s lymphoma. J Clin Pathol. 2007; 60:397-402.
3. Mbulaiteye SM, Devesa SS. Burkitt’s lymphoma incidence in five continents. Hemato 2022; 3:434-453.
4. Winter JR, Lewis JE, Taylor GS, Thomas OG, Stagg HR. Predictors of Epstein_barr Virus serostatus and implications for vaccine policy. J glob Health. 2020; 10:010404.
5. Yaqo RT, Jalal SD, Ghafour KJ, Hassan HA, Hughson MD. non-Hodgkin lymphoma in the Middle East is characterized by low incidence rates with advanced age. JGlob Oncol. 2019; 5:1-10.
6. Muhealdeen DN, Shwan A, Yaqo RT, Hemin A H. Muhammed BO, Ali RM, Hughson MD. Epstein-Barr virus and Burkitt’s lymphoma. Associations in Iraqi Kurdistan and twenty-two countries assessed in the international incidence of childhood cancer. infectious agents and cancer 2022; (17)39: 1-9.
7. Yaqo RT, Hughson MD, Sulayvani FK, Al-Allawi. Malignant lymphoma in northern Iraq; A retrospective analysis of 270 cases according to the World Health Organization Classification. Indian Journal of Cancer 2011; 48:446-451.
8. Anwar N, Kingma DW, Bloch AR, Mourad M, Raffeld M, Franklin J, et al. The investigation of Epistein Barr Virus sequences in 41 cases of Burkitt’s lymphoma from Egypt. Cancer1995; 76:1245-52.
9. Di Maio D, Emu B, Goodman AL, Mothes W, Justice A. Cancer microbiology. J. Natl. Cancer Inst. 2021;114: 651-663.
10. Schmitz R, Ceribelli M, Pittaluga S, Wright G, Staudt LM. Oncogenic Mechanisms in Burkitt’s lymphoma. Cold Spring Harb Persepct Med:2014; 4: a014282.
11. Swerdlow SH, Campo E, Pileri SA, Harris NL, Stein H, Siebert R, et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood. 2016;127 (20):2375-90.
12. Wilkinson DG: In Situ Hybridization, A Practical Approach, Oxford University Press (1992) ISBN 0 19 963327 4.
13. Costa LJ, Xavier AC, Wahlquist AE, Hill EG. Trends in survival of patients with Burkitt’s lymphoma/leukemia in the USA: an analysis of 3691 cases. Blood. 2013;121(24):4861–4866.
14. Farid E Al-Biltagi M. Trend and seroprevalence of Epstein-Barr virus in Bahrain; 2001-2015. East Mediterr Health J. 2017; 23:821-829.
15. Mustafa M, Al Ruhaibeh M, Al Issa A, Nazmi Kamal, Belal Elhawwari. Lymphoma at king Hussein Medical Center; A histopathologic review. J Royal Medical Services2013; 20:27-32.
16. U Ertem, F Duru, A Pamir, N Tacyildiz, A Dagdemir, A Akcayoz et al. Burkitt’s lymphoma in 63 Turkish children diagnosed over 10-year period. Pediat Hematol Oncol 1996; 13:123-134.
17. McClure RF, Remstein ED, Macon WR, Dewald GW, Habermann TM, Hoering A. Adult B-cell lymphomas with burkitt-like morphology are phenotypically and genotypically heterogeneous with aggressive clinical behavior. Am J Surg Pathol. 2005;29(12):1652-60.
18. Giuseppe P, Rosanna Z, Mirella P, Maria CP, Simona C, Pasquale S et al. The role of EBV in the pathogensis of Burkitts’s lymphoma; An Italian hospital-based survey. Infectious Agent Cancer, 2014:9 (34);1-11.
How to Cite
TOMA YAQO, R. (2023). A STUDY ON BURKITT’ S LYMPHOMA AND EPSTEIN-BARR VIRUS LATENCY IN DUHOK, IRAQ. Duhok Medical Journal, 17(2), 12-20. Retrieved from https://dmj.uod.ac/index.php/dmj/article/view/256