A review of Burkitt's lymphoma. Importance of radiographic diagnosis

Medical management update: Non-Hodgkin lymphoma

Lymphoma is a heterogeneous malignancy of the lymphatic system characterized by proliferation of lymphoid cells or their precursors. Non-Hodgkin lymphoma (NHL) is associated with significant morbidity and is the seventh leading cause of death in the United States. Manifestations of NHL as well as complications of the disease and its management are frequently encountered in the head and neck region and often require specific treatment and modifications in the provision of oral health care. The purpose of this article is to review current concepts of the pathophysiology, as well as medical and oral health care management of NHL.

Primary non-odontogenic tumors of the jawbones: an overview of essential radiographic findings

The jawbones, namely the maxilla and mandible, can be the sites of a multitude of neoplastic conditions. Given the variety of processes affecting this particular anatomic area, formulation of a precise diagnosis often can be challenging to the radiologist and the clinician, who may not be familiar with the imaging findings fundamental to diagnosis. Although advanced imaging methods have been developed, routine radiography remains the mainstay in the initial assessment of osseous lesions involving the jawbones. We review and summarize the imaging appearances of non-odontogenic tumors of the jawbones and illustrate example cases of these uncommon neoplasms of bone. Detailed patient history, physical examination, laboratory evaluation and histopathologic analysis are of paramount importance in diagnostic approach and, in most cases, are to be considered in the imaging evaluation of a given lesion. Correct interpretation of the imaging features of lesions involving the jawbones suggests the diagnosis, aids in presurgical planning and improves patient management.

A case of Burkitt's lymphoma that presented initially with resorption of alveolar bone

A 16-year-old male was evaluated for a 1-month history of alveolar bone resorption, which had been treated with endodontics by a neighborhood dentist. Intraoral examination showed slight gingival swelling and teeth mobility. However, no tumor mass was seen. The panoramic image showed resorption of alveolar bone and loss of teeth lamina dura. Because he complained of general fatigue, he was introduced to the internist. Biopsies of gingiva and bone marrow aspiration revealed a massive proliferation of lymphoblasts expressing CD10, 19, 20 and HLA-DR antigens on the surface. Their karyotypes were abnormal; 46, XY, t (8;14) (q24;q32). Accordingly, he was diagnosed as Burkitt's lymphoma, and received intensive chemotherapy which relieved his symptoms and decreased his tumor. However, his disease soon became refractory to chemotherapy, and he died 11 weeks after the onset.

Burkitt's lymphoma of the oral cavity in Israel

The clinical presentation of Burkitt's lymphoma in the maxillofacial area is variable. The objective of this study is to review and analyse all cases of Burkitt's lymphoma with oral or maxillofacial involvement diagnosed in our department. A retrospective review of patients with Burkitt's lymphoma in the facial area between the years 1978 and 1997 was undertaken. The patients, 8 male and 5 female, were from 7 to 50 years old (mean 15.3 years). Six patients were Stage I and 7 were Stage II. Five had abdominal involvement and 2 lymph node involvement besides the maxillofacial presentation. Three tumours were in the mandible, 3 in both mandible and maxilla, 2 in the palate, and 5 in the maxilla alone. In 5 patients the tumour presented as a facial swelling, in 3 as an exophytic mass, in 2 as an ulcer, 1 case presented as a hyperplastic lesion, and 2 were periapical lesions. Complaints included pain (7), swelling (5), and sensory disturbance (2). EBV titres were positive in 4 patients. Abdominal involvement was only seen in patients under 12 years old. All patients were treated with chemotherapy, while adjuvant radiotherapy was indicated in 3 cases. Follow-up of 1-20 years revealed a 2-year survival rate of 61.5%. It seems that the Israeli disease is between that of the African and American types, when considering age distribution.

Burkitt's lymphoma presenting as lower lip paraesthesia in a 24 year old Nigerian. Case report

An unusual case of stage D Burkitt's lymphoma in a 24 year old Nigerian female undergraduate is reported. There was a four month history of left lower lip paraesthesia followed three months later by a slowly progressive 'pimple-sized' nodular mandibular swelling arising from the mental foramen region. A full-blown, rapidly developing abdominal mass manifested only three weeks after a biopsy of the mandibular swelling. Aspiration of the latter and a histologic report of the mandibular mass confirmed Burkitt's lymphoma. The patient responded very well to appropriate chemotherapy. Clinicians should not overlook insidious jaw swellings in any adult residing in the endemic zone of Burkitt's lymphoma, in view of the fact that successful therapy is dependent on early diagnosis. Mental nerve paraesthesia is very rarely seen in Burkitt's lymphoma.

Burkitt's lymphoma involving the mandible: report of a case and review of Japanese cases

A Japanese case of Burkitt's lymphoma is presented. The intraoral and panoramic images showed alveolar bone destruction with an infiltrative border, displacement of lower molars, root resorption, and loss of lamina dura and the follicular cortex of a developing tooth, similar to descriptions in previous reports. Computed tomography revealed that a primary lesion occupied the mandible and extended to the muscles of facial expression and to the sublingual and submandibular spaces. Another soft tissue mass was evident in the contralateral parapharyngeal space. Results of a survey of the Japanese literature are also presented; they indicate differences in the clinical features between Japanese cases and African and American cases of Burkitt's lymphoma.

Burkitt's lymphoma mimicking an acute dentoalveolar abscess

Burkitt's lymphoma is a monoclonal proliferation of B lymphocytes classified histologically as a poorly differentiated lymphocytic lymphoma. The jaw and retroperitoneal structures are the most commonly involved sites. Prognosis is highly dependent on the stage of the disease. In some cases, the first manifestation of Burkitt's lymphoma is in the jaws, and symptoms may be misdiagnosed as infection. Dental radiographs can play an important role in the diagnosis. A case of a peculiar Burkitt's lymphoma involving the mandible that was misdiagnosed as an acute dentoalveolar abscess is presented.

Head, neck, and maxillofacial childhood Burkitt's lymphoma: a retrospective analysis of 31 patients

Thirty-one children with Burkitt's lymphoma of the head, neck, and maxillofacial region diagnosed between 1976 and 1988 were reviewed. The age range was 2 to 17 years (median, 7.2 years), and 77.4% were males. The most common presenting symptoms were detectable masses, floating and/or painful teeth, enlarged cervical lymph nodes, sore throat, and neurologic signs. The predominant primary tumor sites were the jaws and tonsils. All patients were staged by a clinical staging system, 17 of them having stage I-II, and 14 stage III-IV. Levels of lactate dehydrogenase and ferritin were the only significant laboratory parameters correlating with initial staging and disease-free survival. Radiologic features in the jaws were poorly circumscribed destructive lytic lesions with migration and crypt destruction of unerupted teeth buds. Complete disappearance of these findings was noted after successful chemotherapy and clinical regression of the tumor. Eighteen (58.1%) patients attained complete remission with a follow-up of 5 to 100 months. Stage was the most significant variable affecting outcome, with 90.2% disease-free survival of stage I patients, 72.4% of stage II, and 18.2% of stage III-IV. Based on these results, it is concluded that localized (stage I and II) Burkitt's lymphoma is responsive to chemotherapy and thus has a favorable prognosis.

Non-Hodgkin's lymphomas presenting through oral symptoms

Non-Hodgkin's lymphomas (NHL) presenting through oral symptoms are rare. Between 1976 and 1987, a total of 17 cases (7 male, 10 female) were diagnosed in our departments. The first symptom was an intraoral tumour mass in 9 cases, loosening of teeth in 2 cases and paraesthesia in another 2. Most tumours (13/17) were located in the lower jaw. In only 5 cases had the referring physician or dentist suspected malignancy. In 3 cases, the histological diagnosis was Burkitt's lymphoma. The grade of malignancy was classified as low in 4 cases, intermediate in 3 and high in 8. None of the patients was HIV-positive. Nine patients died of their disease within 1-132 months (mean 18.3 months).

American Burkitt's lymphoma: a 10-year review and case study

Burkitt's lymphoma is a malignancy of B-lymphocyte origin that was initially described in African children with jaw tumors. These tumors often spread to involve abdominal viscera and other sites, have rapid growth kinetics, and are principally responsive to chemotherapy. Prolonged survival is predicted by site and extent of tumor, with bone marrow and central nervous system involvement being indicators of a poor prognosis. The dental practitioner plays an important role in diagnosis of jaw lesions and treatment throughout the course of the disease. An examination of 17 cases of Burkitt's lymphoma diagnosed at The North Carolina Memorial Hospital, University of North Carolina at Chapel Hill, North Carolina, over a 10-year period is undertaken and an illustrative case study is presented to demonstrate the challenge of caring for the patient with Burkitt's lymphoma.

Burkitt's lymphoma in the mandible--a case report

Burkitt's lymphoma is a tumour that most often affects the jaws, especially in endemic areas of Africa. In non-endemic areas, the jaws are affected in about 15-18% of cases. A case is presented which demonstrates the significance of jaw lesions in the disease. The history and pathogenesis of the disease also are discussed.

Burkitt's lymphoma of the jaws in Lagos. Ten-year review

This paper presents a review of Burkitt's lymphoma of the jaws seen at the Lagos University Teaching Hospital. The debate on certain aspects of the disease, particularly the pathogenesis, has also been reviewed, while the experience gained in the management has been included.

Non-endemic Burkitt's lymphoma

Burkitt's lymphoma, characterized by jaw and abdominal tumors, is the most common early childhood malignancy in Central Africa and well-known in the United States, with only sporadic reports coming from other countries. Considered to be the fastest growing tumor in man, it is thought to be of viral etiology with warm, humid climate and malaria regarded as co-factors. This is the first case of Burkitt's lymphoma reported from Greece.

Nonendemic American Burkitt's lymphoma

A case of nonendemic American Burkitt's lymphoma with jaw involvement is presented. The oral findings are described and the distinctions of American form of the disease from the African form are discussed.