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ORIGINAL ARTICLE Table of Contents   
Year : 2003  |  Volume : 13  |  Issue : 1  |  Page : 17-18
Case report : Burkit's lymphoma - classical presentation of a rare tumor


Department of Radiodiagnosis, Pravara Rural Medical College, Loni, India

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Keywords: lymphoma, Burkitt, Mandible

How to cite this article:
Tara N P, Dubey R B, Desai S M. Case report : Burkit's lymphoma - classical presentation of a rare tumor. Indian J Radiol Imaging 2003;13:17-8

How to cite this URL:
Tara N P, Dubey R B, Desai S M. Case report : Burkit's lymphoma - classical presentation of a rare tumor. Indian J Radiol Imaging [serial online] 2003 [cited 2019 Oct 23];13:17-8. Available from: http://www.ijri.org/text.asp?2003/13/1/17/28617
An 8 year old boy came with a painful swelling over the lower jaw since 3 days. There was no history of fever, halitosis or dental caries. On examination, a bony hard, tender swelling was palpable over the entire lower jaw with loosening of most of the mandibular teeth. He was advised plain radiography.

Plain radiograph of the mandible a-p projection [Figure - 1] showed loss of the lamina dura of the mandibular teeth. A soft tissue mass was noted in the region of the mandible causing bony destruction with loose teeth floating on top of it. No evidence of calcification was noted in the mass. The maxilla appeared to be spared.

Ultrasonography of the patient's abdomen and pelvis was performed [Figure - 2]. It revealed the presence of multiple heterogeneous, predominantly cystic masses arising from both the kidneys. There was no evidence of abdominal lymphadenopathy, hepatic or splenic focal lesion.

Ultrasonography of the mandibular swelling [Figure - 3] showed a heterogeneous mass lesion involving the mandible with multiple hyperechoic foci within it having posterior acoustic shadowing suggestive of loose teeth.


   Discussion Top


Burkitt's lymphoma is a rare and remarkable disorder, first described by Burkitt's from Kampala, Uganda in 1958[1]. It is a form of non-Hodgkin's lymphoma. It is endemic in central Africa, where it is the commonest childhood malignancy and is strongly associated with Epstein-Barr virus infection. Non-endemic Burkitt's lymphoma is rare, occurs primarily in North America and is not associated with Epstein-barr virus [2]. It is probably the fastest growing human malignancy [3].

Clinically, it consists of large extra lymphatic tumors of the jaw and abdominal viscera, particularly the kidneys, ovaries and retroperitoneal structures [1]. Involvement of the facial bones is characteristic in the African form while abdominal masses and gastrointestinal involvement are more common in the American form [4]. Destruction of the maxilla and less frequently, the mandible produces facial disfigurement [5]. Less frequently the femur and tibia may be involved [6]. Affection of the orbits, meninges, extradural spaces, nasopharynx and lymphnodes has also been reported [2].


   Radiology Top


The first sign is a patchy infiltrative process beneath the alveolus, which causes resorption of the lamina dura [3]. This quickly develops into a massive lytic lesion with obscuration of the trabeculae of cancellous bone and destruction of the tooth buds. These dislodged teeth appear to float on the tumor mass [1]. With disruption of the cortex, a soft tissue mass may extend into the buccal cavity or maxillary antrum.

Radiological evidence is very important in the staging of disease [1].


   Differential diagnosis Top


Eosinophilic granuloma

Hyperparathyroidism

Odontogenic cyst


   Pathology Top


Tumor cells are characteristically round or oval with a monotonous, uniformly undifferentiated cellular pattern. Interspersed are macrophages, giving a classical 'starry sky' effect at low power [1].

Combinations of c-myc and ig gene rearrangements are the hallmark of this and other similar b-cell malignant transformations [7]. Association with Epstein-barr virus infection has been implicated.


   Prognosis Top


Diagnosis and instigation of treatment is occasionally a matter of urgency, to be accomplished in 24 to 48 hours [1]. Without adequate and appropriate therapy, affected children invariably die within 6 months [1].


   Treatment Top


Systemic chemotherapy is the treatment of choice. Combination therapy can achieve a survival rate of 20-50%, the commonest complication being CNS relapse [1].


   Conclusion Top


It is important to consider Burkitt's lymphoma in the differential diagnosis of a mass lesion involving the maxilla and mandible in a young boy as it can be rarely seen as a sporadic case outside Africa.

 
   References Top

1.Murray RO, Jacobson HG, Stoker DJ. Ed. Burkitt's lymphoma. In: the radiology of skeletal disorders - exercises in diagnosis; 3rd Ed, 1440. Churchill Livingstone; 1990.  Back to cited text no. 1    
2.Ziegler JL. Burkitt's lymphoma. N Engl J Med 305; 735-745; 1981.  Back to cited text no. 2    
3.Parker BR, Marglins, Castellino RA. Skeletal manifestations of leukemia, Hodgkin's disease & Non-Hodgkin's Lymphoma. Semin Roentgenol 15: 307, 1980.  Back to cited text no. 3    
4.Baker CG, Tishler JM. Malignant disease in the jaws. J Can Assoc Radiol 28: 129, 1977.  Back to cited text no. 4    
5.Resnick D, Haghighi P. Myeloproliferative disorders. In. Resnick D & Niwayama. G. Diagnosis of bone & joint disorders - vol 4, 2nd ed. WB Saunders & Co; 1988.  Back to cited text no. 5    
6.Huvos AG. Ed. Skeletal manifestations of malignant lymphomas and leukemias. In bone tumors - diagnosis, treatment and prognosis, 2nd ed. WB Saunders & Co; 1991.  Back to cited text no. 6    
7.Som PM, Brandwein M. Sinonasal cavities: inflammatory disease, tumors, fractures and post-operative findings. In. Som PM, Curtin HD. Head & neck imaging, vol.1, 3rd ed, 1440. Mosby - Year Book, 1996.  Back to cited text no. 7    

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Correspondence Address:
N P Tara
Department of Radiodiagnosis, Pravara Rural Medical College, Loni
India
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Source of Support: None, Conflict of Interest: None


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    Figures

[Figure - 1], [Figure - 2], [Figure - 3]

This article has been cited by
1 Abdominal visceral involvement in non-endemic Burkittęs lymphoma
Vijay, S., Dahiya, N., Karthikeyan, D., Sudha, G.
Indian Journal of Radiology and Imaging. 2004; 14(2): 225-226
[Pubmed]



 

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    Discussion
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