A 10 yr old boy with mass in the abdomen. On imaging the paraaortic LN is enlarged. On biopsy starry sky appearance is seen. What is the underlying abnormality?
**Core Concept**
The "starry sky appearance" is a characteristic histopathological feature of a specific type of lymphoma in children, known as Burkitt lymphoma. This appearance is due to the presence of numerous mitotic figures, apoptotic cells, and tingible body macrophages that resemble stars in the night sky.
**Why the Correct Answer is Right**
Burkitt lymphoma is a high-grade B-cell lymphoma that arises from germinal center cells. The rapid proliferation of cancer cells leads to the formation of numerous mitotic figures and apoptotic cells, which are then phagocytosed by tingible body macrophages. The resulting histological appearance is characteristic of Burkitt lymphoma, with a "starry sky" pattern due to the presence of these cells. The tumor typically involves the abdominal lymph nodes, including the paraaortic lymph nodes, as seen in this case.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because Burkitt lymphoma is a specific type of lymphoma that is characterized by its rapid growth and the presence of the "starry sky" appearance. Other types of lymphoma, such as diffuse large B-cell lymphoma, may have similar histological features but do not typically exhibit the "starry sky" appearance.
**Option B:** This option is incorrect because Burkitt lymphoma is primarily a childhood cancer, whereas this option suggests a cancer that is more commonly seen in adults.
**Option C:** This option is incorrect because Burkitt lymphoma is a type of B-cell lymphoma, whereas this option suggests a T-cell lymphoma.
**Option D:** This option is incorrect because Burkitt lymphoma is a specific type of lymphoma that is characterized by its rapid growth and the presence of the "starry sky" appearance. Other types of lymphoma, such as follicular lymphoma, may have similar histological features but do not typically exhibit the "starry sky" appearance.
**Clinical Pearl / High-Yield Fact**
Burkitt lymphoma is a highly aggressive cancer that requires prompt treatment. The "starry sky" appearance on histological examination is a key diagnostic feature of this cancer, and awareness of this appearance can help clinicians make an accurate diagnosis.
**Correct Answer:** C.