Burkitt's lymphoma of the oral cavity in Israel

Radiographic Orofacial Findings of Systemic Diseases

This article discusses the orofacial clinicoradiographic features of systemic diseases that manifest in the orofacial region. The systemic diseases discussed are grouped into the following: autoimmune diseases, endocrine diseases, bone diseases, hematologic diseases, syndromes, and malignancies. The radiographic manifestation ranges from radiolucent bony destruction, increased bone density, calcification, thinning of cortical plate, loss of trabeculation, missing teeth, and supernumerary teeth. It is imperative for clinicians to be cognizant of these findings, as they may be the first manifestation of these systemic diseases.

Primary manifestation of HIV-related Burkitt lymphoma in the oral and maxillofacial regions

BACKGROUND

Burkitt lymphoma (BL) is a subtype of non-Hodgkin lymphoma. It is strongly associated with HIV infection and has a highly aggressive clinical course. The involvement of the maxillofacial region in BL has rarely been reported.

CASE DESCRIPTION

A 36-year-old woman with HIV-positive status had painless bilateral swelling of the oral mucosa and middle and lower thirds of the face. Microscopic analysis of the oral lesion revealed an atypical lymphoid infiltrate with a starry sky pattern. The lymphoid cells expressed cluster of differentiation 20, cluster of differentiation 10, B-cell lymphoma 6, and c-Myc; the Ki-67 proliferative index was high. The tumor cells were positive for Epstein-Barr virus. These results led to the diagnosis of HIV-related BL.

PRACTICAL IMPLICATIONS

BL and other immunodeficiency-related lymphoproliferative malignancies may affect the oral and maxillofacial regions and should be included in the differential diagnosis of rapidly expanding swelling in young patients.

First reported case: Uncommon presentation of Burkitt lymphoma as perineal ulceration in a young patient

INTRODUCTION AND IMPORTANCE

Burkitt lymphoma (BL) is an aggressive subtype of non-Hodgkin lymphoma with a predilection for pediatric patients, known for its rapid growth and MYC oncogene-associated chromosomal translocations.

CASE PRESENTATION

A 33-year-old male presented with a perineal ulcerated wound, initially misdiagnosed as a musculoskeletal injury. Imaging and histopathological analysis eventually confirmed BL, leading to the initiation of high-dose chemotherapy.

CLINICAL DISCUSSION

BL is characterized by its rapid growth, typically as masses in the abdomen or jaw. Nevertheless, atypical presentations can lead to diagnostic delays, underscoring the importance of considering BL even in the absence of classic symptoms. Swift recognition and accurate diagnosis are critical for initiating timely chemotherapy. Comprehensive clinical evaluation, advanced imaging, and histopathological analysis are pivotal in confirming the diagnosis.

CONCLUSION

This unique case of BL with a perineal mass presentation emphasizes the necessity of considering BL as a potential diagnosis in atypical cases, highlighting the importance of early recognition and appropriate therapeutic strategies. Healthcare professionals should be aware of the potential for unusual BL presentations.

Delayed diagnosis of oral lymphoma: a case series

Lymphomas are the second most common neoplasm in the head and neck. The clinical and radiographic presentation of non-Hodgkin lymphoma in the oral cavity is non-specific and can be hard to differentiate from other common infectious or inflammatory conditions. We report four cases of lymphoma of the head and neck, which presented as odontogenic infection, osteomyelitis, or cutaneous infection, and subsequently led to a delay in provision of appropriate treatment. Correlation between clinical, radiographic and histological findings is essential in reaching an accurate diagnosis. It is important for clinicians to consider malignant lesions, such as lymphoma, in the differential diagnosis of pain, swelling, tooth mobility or radiographic radiolucencies. Clinicians should maintain a high level of suspicion for malignancy when inflammatory lesions fail to respond to normal modes of treatment.

Malignant tumours mimicking periapical lesions: A report of three cases and literature review

Apical periodontitis shows radiographic signs such as widening of the periodontal ligament and periapical radiolucency, which differ in extent depending on the stage of the lesion. However, other lesions can be associated with or coincidental to the apical region, representing developmental lesions and benign or malignant tumours. This article describes three cases of malignant tumours, a central mucoepidermoid carcinoma (CMEC), a chondroblast osteosarcoma and an osteosarcoma of the jaw (OSJ) that presented as periapical lesions. Endodontists must be aware of unsuccessful treatment, persistent pain, signs of paraesthesia, a rapid growth rate and delayed response to therapy associated with atypical features. Complementary examinations, such as biopsy and computed tomography, can allow the early diagnosis of malignant tumours, leading to a better prognosis and thus increased survival rates and improvement in quality of life.

Effect of Meloxicam on the Proliferation and Apoptosis of the Raji Cell Line: an In Vitro Study

Meloxicam, a nonsteroidal anti-inflammatory drug, inhibits the production of PGE2 by blocking Cox-2 activity. Specific inhibition of Cox-2 can be useful in cancer therapy by apoptosis stimulation. The objective of the research was to study the effect of meloxicam on the proliferation and apoptosis of Raji cell lines. Burkitt lymphoma (BL) cells (Raji ATCC CCL-86) were treated with various concentrations of meloxicam for 24 hours. The proliferation of the cells was evaluated by using an MTT assay. Cell apoptosis was assessed using flow cytometry, and SEM was performed to observe the morphological changes of the cells. Results showed that meloxicam affected Raji cell proliferation as well as cell apoptosis. The percentage of viable cells was decreased significantly after being treated with meloxicam (p < 0.05). Apoptotic cell percentage was higher in the groups treated with meloxicam compared to the control group (p < 0.05). SEM showed morphological changes in the Raji cells after treatment with meloxicam, showing apoptotic characteristics. These findings suggest that meloxicam has anticancer properties by inhibiting Raji cell proliferation and inducing Raji cell apoptosis in vitro. A combination of meloxicam with chemotherapy agents may improve the outcome of BL treatment.

The Primary Outbreaks of Burkitt Lymphoma in the Oral Cavity. A Report of Two Cases, Review of the Literature and Dental Implications

Two cases of Sporadic Burkitt’s lymphoma in children aged 11 and 8 years with primary symptoms in the oral cavity are reported. The first symptoms of the disease appeared in the oral cavity and were initially misdiagnosed as an inflammatory condition in one case and incidental findings not associated with the primary reason for visiting the dentist’s office in the second case. Biopsies of the lesions revealed the actual cause of the observed changes and contributed to the prompt initiation of polychemotherapy treatment. A review of current literature presents the known symptoms of Burkitt’s Lymphoma in the oral cavity and the available diagnostic methods. The role of the primary care physicians—the pedodontist and paediatrician—in the diagnostic and therapeutic process is discussed.

Bilateral jaws involvement of Burkitt's lymphoma in a pediatric patient

A case of Burkitt's lymphoma with bilateral jaws involvement in a 5-year-old boy is reported discussing the dentist's role in the diagnosis and management of this disease. The initial clinical diagnosis established of maxillary swelling causing trismus was a dentoalveolar abscess. The incisional biopsy was performed and histopathological analysis, including immunohistochemistry, confirmed the Burkitt's lymphoma. The patient underwent treatment and remains free of the disease for 36 months of follow-up. The occurrence of intraoral bilateral jaws involvement of Burkitt's lymphoma in child is unusual and its accurate diagnosis avoids complications in the patient's treatment. Key words:Burkitt's lymphoma, Non-Hodgkin's lymphoma, Oral cavity, Maxilla, Child.

Clinicopathological analysis of oral Burkitt's lymphoma in pediatric patients: A systematic review

The aim of this study was to integrate the available data regarding pediatric Burkitt's lymphoma (BL) of the oral cavity. A systematic review was conducted following PRISMA guidelines, through a specific search strategy. Twenty-nine publications were included in this study, resulting in a total of 144 cases. Oral BL was predominantly found in males (75.7%). The mandible was the most involved site (37.5%), and all cases clinically exhibited a swelling. Presence of EBV was observed in 33.3% of the cases, and 4 cases reported HIV-positive patients (33.3%). Chemotherapy was the leading treatment choice for oral BL (94.9%), and the overall 5-year survival was 54.3%. Regarding the quality assessment of the studies, most (19 studies; 65.5%) were classified as an overall moderate risk of bias. In conclusion, the clinicopathological characteristics of oral BL in the pediatric population comprise the sporadic and intermediate subtypes. Despite its aggressiveness, this malignancy presents a moderate overall survival.

Periapical lymphoma: Review of reported cases in the literature

Oral lymphoma can resemble clinically to other pathologic entities such as periapical radiolucencies, or dental abscess. The aim of this study was to review the literature related to misdiagnosed periapical lymphomas and discuss their characteristics. In this review study, authenticated search engines and databases such as Google Scholar, PubMed, PubMed Central, Science Direct, and Scopus were surfed to find articles related to the topic by using related keywords. Out of more than 100 articles approximately, 50 were closely relevant to the title, and ultimately 43 well-documented English articles were chosen. Out of 45 reported cases, 63% were male and 37% were female with mean age of 41.22 years. The majority of such lesions have been detected in the mandible (61%) with a mandibular to maxillary involvement ratio of 1.58:1. The most frequent type of lymphoma was diffuse large B cell lymphoma (DLBCL) (53%). Noteworthy, 49% of periapical lymphoma has been misdiagnosed as pulpal pathology and treated through root canal therapy. The mean time lapse before making the correct diagnosis was 4.3 months. Although rare, periapical lymphoma should be ranked in the differential diagnosis of a periapical lesion especially when vitality pulp tests are positive.

Burkitt's Lymphoma of the Base of the Tongue: A Case Report and Review of the Literature

Burkitt's lymphoma is a highly aggressive, mature B cell non-Hodgkin's lymphoma that is rare outside Africa. We report a case of Burkitt's lymphoma presenting as a rapidly expanding tongue-base mass that caused airway obstruction in an 80-year-old Palestinian man living in California. According to our review of the literature, this is only the third reported case of Burkitt's lymphoma arising in the base of the tongue. We also discuss the incidence, epidemiology, genetics, prognosis, and treatment of this malignancy. Because Burkitt's lymphoma is one of the fastest-growing tumors in humans, rapid diagnosis and treatment are important. Treatment involves brief-duration, high-intensity chemotherapy and central nervous system prophylaxis. It is important for the otolaryngologist to recognize this disease and to understand the steps necessary to treat this aggressive tumor.

Maxillary Sinus Natural Killer/T-Cell Extranodal Lymphoma Mimicking a Dentoalveolar Abscess

Extranodal natural killer/T-cell lymphoma (ENKL) is an aggressive and infrequent malignant neoplasm. Early sinonasal ENKL clinical symptomatology is often not specific which can mimic several clinical odontogenic processes such as dentoalveolar abscesses. A 41-year-old female was referred to our institution due to facial pain with skin rash, fever, and intraoral swelling in the left side of the maxillary region. Computed tomography (CT) revealed a soft tissue hypodense area in the left side with bone discontinuity in anterior and lateral maxillary sinuses. Initial laboratorial tests showed no alterations on hemogram, coagulation profile, and immune phenotype (CD3⁺/CD4⁺). However, the lesion progressed fastly showing an evident growth, so it was decided that an intraoral biopsy should be performed. The diagnosis was sinonasal ENKLs. This case is an example that the rare T-cell lymphoma can mimic an odontogenic lesion, thus puzzling the clinician. Fortunately, the rapid growth of the lesion prompted the correct diagnosis and early treatment.

Epstein-Barr virus in the pathogenesis of oral cancers

Epstein-Barr virus (EBV) is a ubiquitous gamma-herpesvirus that establishes a lifelong persistent infection in the oral cavity and is intermittently shed in the saliva. EBV exhibits a biphasic life cycle, supported by its dual tropism for B lymphocytes and epithelial cells, which allows the virus to be transmitted within oral lymphoid tissues. While infection is often benign, EBV is associated with a number of lymphomas and carcinomas that arise in the oral cavity and at other anatomical sites. Incomplete association of EBV in cancer has questioned if EBV is merely a passenger or a driver of the tumorigenic process. However, the ability of EBV to immortalize B cells and its prevalence in a subset of cancers has implicated EBV as a carcinogenic cofactor in cellular contexts where the viral life cycle is altered. In many cases, EBV likely acts as an agent of tumor progression rather than tumor initiation, conferring malignant phenotypes observed in EBV-positive cancers. Given that the oral cavity serves as the main site of EBV residence and transmission, here we review the prevalence of EBV in oral malignancies and the mechanisms by which EBV acts as an agent of tumor progression.

Primary non-Hodgkin's lymphoma of the tongue: a diagnostic dilemma of unusual case presentation

Primary non-Hodgkin's lymphoma of the tongue is extremely uncommon, which makes its diagnosis quite challenging. A panel of 11 markers is used based on morphological differential diagnosis to elucidate the lymphoma subtype. A case of 43-year-old Egyptian man suffering from nodular mass on the right side of the tongue of 4 months duration is presented. No cervical lymphadenopathy was detected. No abdominal organomegaly was noted. The histological evaluation of incisional biopsy revealed a sheet of pleomorphic lymphoid cells with abnormal mitotic figures. A large number of histiocytes were infiltrating the lymphoid cellular sheet. The results of immunophenotyping were extranodal T-cell lymphoma. A proper immunohistochemical workup is crucial for the correct diagnosis and proper management.

Oral manifestations of lymphoma: a systematic review

Lymphoma is a malignant disease with two forms: Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL). Non-Hodgkin's lymphoma is diagnosed in extranodal sites in 40% of cases, and the head and neck region is the second most affected, with an incidence of 11-33%, while HL has a very low incidence in extranodal sites (1-4%). The aim of this study was to identify the oral manifestations of lymphoma through a systematic literature review, which we conducted using the PubMed, Lilacs, Embase, and Cochrane Library databases. We found 1456 articles, from which we selected 73. Among the intraoral findings, the most frequent were ulcerations, pain, swelling, and tooth mobility, while the extraoral findings included facial asymmetry and cervical, submandibular, and submental lymphadenopathy. Among the few studies reporting imaging findings, the most cited lesions included hypodense lesions with diffuse boundaries, bone resorptions, and tooth displacements. The publications reviewed highlight gaps in the areas of early detection, diagnosis, and proper treatment.

An unusual case of Burkitt's lymphoma presenting as a gingival enlargement

Burkitt's lymphoma is an undifferentiated non-Hodgkin's B-cell lymphoma. Three clinical subtypes are recognized: African (endemic), American and other areas (sporadic) and human immunodeficiency virus (HIV) associated. Sporadic Burkitt's lymphoma is a rare malignancy among Asian population. This report describes a case of sporadic Burkitt's lymphoma presenting as generalized gingival enlargement with an alarmingly rapid spread. This type of rapid progression bespeaks the need for prompt recognition and life-saving referral by the dental practitioner. The purpose of this case report and review of the literature was to illustrate the fact that an inconspicuous and benign looking gingival enlargement may turn out to be an aggressive malignancy like Burkitt's lymphoma.

Maxillary sporadic Burkitt's lymphoma associated with neuro-orbital involvement in an Indian male

Burkitt's lymphoma (BL) is the fastest growing malignancy of the lymphoreticular system to affect humans and has a potential ability to double in size every day. A case of maxillary sporadic BL (sBL) associated with neuro-orbital involvement in an Indian male is presented. sBL initially presented as maxillary swelling with no obvious dental and periodontal changes. Histological specimen from incisional biopsy revealed a round cell malignant tumor and immunohistochemistry reactions favored nonHodgkin's lymphoma consistent with BL. Four weeks later, patient presented with orbital involvement as diplopia, sixth cranial nerve palsy, and medial rectus palsy. Chemotherapy regimen according to LMB 89 protocol was started. During chemotherapy regimen patient showed bradycardia and Babinski response, suggestive of central nervous system involvement. sBL associated with orbital involvement is extremely rare and only seven cases have been reported. Our case showed unusual presentation; despite the aggressive tumor did not show any common clinical, radiological, and hematological findings. We also discussed the role of oral medicine specialist, importance of early diagnosis, and prompt referral in management of maxillary sBL.

A child with Burkitt lymphoma with pleural, peritoneal, mesenteric, omental, and renal involvement: diagnostics by FDG PET/CT

A 7-year-old boy presented with increasing abdominal girth and abdominal pain. Abdominal ultrasound revealed a pleural effusion and ascites. Computed tomography (CT) demonstrated a mass involving the peritoneum, mesentery, and omentum with marked ascites, mesenteric nodules, and renal involvement. Positron emission tomography (PET)/CT scan identified additional tumor within the pleura. PET/CT imaging was helpful in identifying the appropriate pleural mass biopsy site in this patient with Burkitt lymphoma.

Burkitt lymphoma of the oral cavity: an atypical presentation

Burkitt lymphoma (BL) is an aggressive form of non-Hodgkin B-cell lymphoma with 3 variants: endemic, sporadic, and immunodeficiency-associated types. The sporadic form, most commonly involving the abdomen and ileocecal region, presents as an abdominal mass, rarely presenting in the orofacial region. A 36-year-old Indian female presented to the Hospital of the University of Pennsylvania for evaluation of a persistent intraoral swelling ulceration of the lower right mandibular alveolar ridge with minimal bony invasion. Progressive systemic symptoms of fatigue, weakness, and fever developed without resolution following treatment for a presumed odontogenic infection in the 4 weeks before presentation. An incisional biopsy revealed a diffuse proliferation of intermediate- to large-sized lymphocytes with multiple small peripheral nucleoli, scant cytoplasm, and nuclear pleomorphism. Nearly all cells displayed Ki67 expression. A final diagnosis of BL was rendered following confirmation of a cMYC translocation by fluorescence in situ hybridization. This article presents a case of the sporadic form of BL with atypical presentation clinically and morphologically, primarily involving the oral soft tissue.

Oral Burkitt's lymphoma--case report

Burkitt's lymphoma is a poorly differentiated rare and aggressive type of non-Hodgkin's lymphoma. This article reports the case of a male child aged seven years, who was examined at the Odontopediatric Clinic of the UFRN Dentistry Department. The patient presented a tumor in the premolar region of the mandible; teeth were mobile in this region. Radiology revealed a diffuse radioluscent area which was diagnosed histopathologically as Burkitt's lymphoma. The patient was treated with polychemotherapy; complete remission of the disease was attained.

Linfoma de Burkitt oral: relato de caso

O linfoma de Burkitt é um raro e agressivo tipo de linfoma não-Hodgkin pobremente diferenciado. O presente relato trata de uma criança do sexo masculino, com sete anos de idade, que foi examinada na Clínica de Odontopediatria do Departamento de Odontologia da UFRN, exibindo uma massa tumoral na região de pré-molares mandibulares com mobilidade dentária. O exame radiográfico revelou uma área radiolúcida difusa e o diagnóstico histopatológico foi de linfoma de Burkitt. O paciente foi tratado por poliquimioterapia e obteve completa remissão da patologia.

Epstein-Barr virus in oral diseases

Epstein-Barr virus (EBV), a B-lymphotropic gamma-herpesvirus, causes infectious mononucleosis and oral hairy leukoplakia, and is associated with various types of lymphoid and epithelial malignancies. Saliva is the main vehicle for EBV transmission from individual to individual. Recent studies have also implicated EBV in the pathogenesis of advanced types of periodontal disease. EBV DNA is detected in 60-80% of aggressive periodontitis lesions and in 15-20% of gingivitis lesions or normal periodontal sites. The periodontal presence of EBV is associated with an elevated occurrence of periodontopathic anaerobic bacteria. Moreover, EBV active infection occurs in approximately 70% of symptomatic and large-size periapical lesions. EBV and cytomegalovirus often co-exist in marginal and apical periodontitis. Periodontal therapy can markedly suppress the EBV load in periodontal pockets as well as in saliva, which has the potential to reduce the risk of viral transmission between close individuals. EBV proteins up-regulate cytokines and growth factors, which seem to play a central role in the proliferative response of tongue epithelial cells in oral hairy leukoplakia and in the cell-transformation process of EBV-associated malignancies. Further research is needed to identify the full range of EBV-related diseases in the human oral cavity.

Pediatric Burkitt's lymphoma: CT findings

PURPOSE

To review and analyze all CT scans of the cases of Burkitt's lymphoma (BL) in children diagnosed in our institution.

MATERIALS AND METHODS

A retrospective analysis of 33 children with BL between the years 2003 and 2005 seen in our institution was undertaken. Twenty-nine male and four female patients from age 3 to 16 years (with a mean age 5.9 years) were reviewed.

RESULTS

The gastrointestinal tract was involved in 19 patients (57.5%), kidneys in 9 (27.2%), peritoneum in 8 (24.2%), liver in 4 (12.1%), spleen in 3 (9%), adrenals in 3 (9%), and pancreas in 1 patient (3%). Extra-nodal head and neck involvement was seen in eight patients (24.2%). Bone involvement in four (12.1%), lung in three (9%), heart in two (6%), skin in two (6%), and testis in one (3%) of these patients. Abdominal lymph nodes were enlarged in 21 children (63.6%), while cervical lymph nodes were enlarged in 8 (24.2%).

CONCLUSION

CT proved to be an invaluable tool in the characterization of the disease processes in these children. In addition, it provided us with useful information about the anatomical distribution, patterns of involvement, as well as complications of BL.

Hodgkin and non-Hodgkin lymphoma of the head and neck: clinical, pathologic, and imaging evaluation

Lymphomas are subdivided into HL and NHL and are more specifically classified into subtypes of HL or NHL according to the WHO classification. HLs involve the lymph nodes predominantly and only approximately 5% arise in extranodal sites, whereas 30% of NHLs present in extranodal sites. Imaging studies, including CT and MR imaging, cannot distinguish [figure: see text] HL from NHL, and cannot differentiate their various subtypes, necessitating a pathologic diagnosis. Clinical parameters, however, can be helpful in differentiating the two broad categories of lymphomas, and subtypes of lymphomas have predilections for different sites within the head and neck. HL is most commonly located in the lymph nodes of the neck and mediastinum. Marginal-zone lymphoma has an affinity for the ocular adnexa, salivary glands, larynx, and the thyroid gland. Diffuse large B-cell lymphoma is commonly encountered in the paranasal sinuses, mandible, maxilla, and Waldeyer ring. Burkitt lymphoma occurs more frequently in children and young adults and frequently affects the maxilla and mandible, with a greater distribution of involvement at a lower frequency. On imaging studies, the lymph nodes of HL and NHL are homogeneous and variable in size, with an average diameter from 2 to 10 cm. They may enhance slightly to moderately, display necrosis before and after treatment, and display calcification post-treatment. NHL in extranodal sites in the head and neck (nasopharynx, Waldeyer ring, oral cavity, and larynx) manifests frequently as a submucosal mass accompanied [figure: see text] by polypoid, bulky masses with a smooth mucosal surface. Clinically aggressive lymphomas, such as Burkitt lymphoma, diffuse large B-cell lymphoma, and NK-/T-cell lymphomas are characterized by destruction of the maxilla, mandible, and bones around the paranasal sinuses, which is indistinguishable from bony destruction in other malignant tumors, such as SCC. Contrast CT is indicated for evaluation of cervical lymph nodes; the chest, including the mediastinum; the pelvic cavity; paranasal sinuses; and orbits. CT is also useful for detection of bone destruction involving the base of the skull, paranasal sinuses, and the mandible or maxilla. MR imaging is preferred for the assessment of extension of lymphomas to different fascial spaces (parapharyngeal, masticator, infratemporal fossa, tongue, and nasopharynx) and for intracranial extension. Lymphomas are isodense to muscle on CT and circumscribed with distinct margins that occasionally display extranodal extension with less-well-defined margins and areas of necrosis within the tumor matrix. Lymphomas appear low in signal intensity on T1-weighted images and low to high in signal intensity on T2-weighted images, with variable, but usually low, enhancement following introduction of Gadolinium-DTPA (Gd-DTPA) contrast material.

Mantle cell lymphoma of the hard palate: a case report and review of the differential diagnosis based on the histomorphology and immunophenotyping pattern

To our knowledge, mantle cell lymphoma (MCL) has never been reported in the hard palate, but it is commonly observed in the nasopharynx and Waldeyer's tonsillar ring. MCL is characterized by a diffuse infiltrate of small lymphocytes with the expression of CD5, CD20, and cyclin D1 (Bcl-1), but not CD10. MCL presenting in the hard palate must be accurately distinguished from other forms of so-called small B-cell lymphomas-such as small lymphocytic lymphoma, follicular lymphoma, and extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue-because MCL possesses a worse prognosis. Awareness of MCL of the hard palate will prompt pathologists to perform adequate immunohistochemical analysis to aid in confirming the diagnosis.