Burkitt's Lymphoma of maxillary sinuses: review of literature and report of bilateral case

Pediatric sporadic Burkitt lymphoma of the head and neck: A case series and analysis of national trends

OBJECTIVE

Burkitt lymphoma (BL) is an aggressive form of non-Hodgkin lymphoma with the sporadic subtype being predominant in North America. The clinical presentations and outcomes of pediatric BL within the head and neck were assessed using both an institutional case series and the Surveillance, Epidemiology, and End Results (SEER) Cancer database.

METHODS

The electronic medical record at our quaternary children's hospital was queried over a 22-year period (2000-2022) for BL patients with head and neck manifestations. Demographics, clinical presentation, staging, treatment, and outcomes data were collected and analyzed. A corresponding review of the SEER database from 1975 to 2022 was also performed.

RESULTS

Our institutional case series identified 48 sporadic BL patients with a mean age of 8.7 years, the majority of whom were male (79 %) and white (74 %). The most common primary sites were the cervical lymph nodes (38 %) and (or) palatine tonsils (23 %). Thirty-five patients (73 %) were treated initially for a presumed inflammatory or infectious process before undergoing malignancy work-up, which did not significantly delay time to diagnosis (31.5 vs. 38.8 days, p = 0.27). The SEER database analysis identified 78 cases, 43.5 % of whom were 5-9 years of age, with a similar male (66 %) and Caucasian (76.9 %) predominance. Cervical lymph nodes were also the most common subsite (67 %), followed by the palatine tonsils (13 %). Remission rates were similar, 93.7 % and 94.8 %, respectively, in both the institutional and SEER database cohorts.

CONCLUSION

Unilateral cervical lymphadenopathy and asymmetric tonsillar hypertrophy are the most common presentations in sporadic BL in the head and neck. Clinical presentation in patients with BL is often similar to common, insidious pediatric otolaryngology symptoms and a majority of patients initially undergo treatment for presumed infectious or inflammatory disease. Although overall BL disease-free survival is high even for disseminated BL, the prognosis is better for local/regional disease, and minimizing time to diagnosis and treatment should remain a priority.

Sinonasal Burkitt Lymphoma in a 2-Year-Old Child: An Uncommon Case Report

Burkitt Lymphoma (BL) is a highly aggressive B-type non-Hodgkin lymphoma. It rarely develops at the level of the sinonasal cavities, especially in young children. We present the case of a 2-year-old boy who presented with a 2-month history of nasal obstruction, snoring, and epistaxis followed by a recent dyspnea. Examination revealed a protruding tissue mass in the left nasal cavity. Computed tomography scan showed a homogenous soft-tissue mass in the left nasal cavity extending toward the ipsilateral orbit, infratemporal fossa, nasopharynx, as well as the ethmoid and maxillary sinuses. Magnetic resonance imaging revealed a homogenous infiltrating mass with a hypo-intense signal on T2-weighted images reaching the infratemporal fossa and oropharynx. Biopsy confirmed the diagnosis of BL. The patient was referred to the clinical hematology department and received complex chemotherapy. Following chemotherapy, imaging revealed significant regression of the mass. We performed a nasopharyngeal biopsy which confirmed the absence of any persistent disease. This case report highlights a rare case of an extensive sinonasal BL emphasizing the importance of a high level of suspicion to ensure an early diagnosis and treatment.

Fortitude and resilience in service of the population: a case study of dental professionals striving for health in Sierra Leone

OBJECTIVE

Sierra Leone (SL), with a population of over 7 million people, has a critical health workforce shortage. This research explores the views of key players on population oral health needs and demands, the challenges of oral and dental care delivery, and professional careers in dentistry, in order to inform future capacity building.

MATERIALS AND METHODS

Semi-structured interviews were conducted with a purposive sample of key players in dentistry and healthcare, both in-country and externally. An interpretive phenomenological approach was used in exploring views of key-players on the oral needs and demands of population, challenges in the delivery of oral and dental care, professional careers of dental professionals in SL, and future workforce capacity building based on a topic guide drawn from the available literature. Interviews were audio-recorded, transcribed verbatim, anonymised and analysed using QSR NVivo 10 for data management and reported in accordance to the consolidated criteria for reporting qualitative research.

RESULTS

Twenty-one informants, of whom 18 were male, 17 were in-country and 16 were dental professionals, participated in the research. Dental professionals reported clear consensus on a considerable level of unmet oral health needs, most notably dental caries and periodontal disease, together with life threatening oral conditions such as osteomyelitis, Ludwig's Angina and Burkitt's Lymphoma. Challenges associated with the delivery of dental care revolved around five themes: patients' predisposition for traditional remedies and urgent care; practical hindrances to the delivery of care; professional isolation and weak governance; and place with pressing local crises and lack of political will. An emerging typology of dental professionals included: demonstrating loyalty to their nation and family; exhibiting resilience in challenging circumstances; embracing opportunity most notably amongst expatriates; and striving to serve the needs of the population. There was support for innovative future capacity building developments.

CONCLUSION

This paper provides important insights to the delivery of dental care in a low-income country with significant oral health needs and multiple challenges in the delivery of dental care, whilst also providing a vision for developing, building and retaining future human resources for oral health.

Sporadic Burkitt Lymphoma Presenting as Acute Pancreatitis, Concurrent Sinusitis, and Enlarged Adenoids

Pancreatitis and sinusitis as presentations of Burkitt lymphoma are uncommon and rarely described in children. We describe here the case of a child who presented with symptoms suggestive of sinusitis unresponsive to antibiotics, with subsequent development of abdominal symptoms due to pancreatitis. He was eventually diagnosed with Burkitt lymphoma.

Primary Burkitt's Lymphoma in the Nasal Cavity and Paranasal Sinuses

Burkitt's lymphoma is a highly aggressive small B-cell lymphoma. The treatment of choice is complex chemotherapy. As a rare tumor in the head and neck area, Burkitt's lymphoma usually involves cervical lymph nodes, and only fewer than 25% of cases involves extranodal regions. Involvement of the paranasal sinuses has been reported in only 14 cases in the past century. We describe here two patients with rare, sporadic, American type Burkitt's lymphoma involving the nasal cavity and paranasal sinuses manifesting nasal obstruction. We also review clinical and histological features of Burkitt's lymphoma.