Discussion:
Burkitt and Burkitt-like lymphomas account for approximately 40% of childhood non-Hodgkin lymphomas.1 Since Burkitt lymphomas are very rapidly growing tumors, the diagnosis should be made with the fastest and least invasive methods. A detailed history and complete systemic examination should be performed on each patient.5,6 Soft tissue and bone infections, benign odontogenic cysts, and malignant tumors (Langerhans cell histiocytosis, Ewing sarcoma, non-Hodgkin lymphomas) should be considered in the differential diagnosis in childhood and adults.7,8
Burkitt lymphoma may show signs such as tooth displacement, dental loss, facial nerve palsy, and orbital swelling.9,10 Patients who apply to the dentist with oral and dental problems and suspected Burkitt lymphoma should be urgently referred to pediatric hematology-oncology centers for diagnosis and treatment.11 Complete blood count, peripheral smear, serum electrolytes (uric acid, phosphorus, urea, creatine, potassium), and LDH levels should be measured. Tumor lysis syndrome may develop in tumors such as Burkitt lymphoma with a high proliferation rate of tumor cells, elevated tumor burden (increased LDH, advanced stage, disseminated disease), and kidney involvement in cancer patients.10,12 Our patient had a high risk of tumor lysis syndrome with elevated LDH levels, disseminated stage IV disease with bone marrow involvement, and renal involvement. There is no central nervous system involvement in this patient. Tumor lysis syndrome is a life-threatening condition characterized by organ dysfunction and metabolic problems such as hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia.2,5 Precautions should be taken in patients at high risk of developing tumor lysis syndrome or if it has developed, it should be treated urgently. Hydration, urine alkalinization and drugs to lower uric acid levels should be given. The high levels of potassium released by the breakdown of tumor cells are life-threatening and should be treated urgently. Hemodialysis may be required in renal involvement without urine output, and metabolic disorders unresponsive to drugs. Our patient’s laboratory findings improved with medical treatment (hydration, allopurinol), adequate urine output was achieved, and he did not need hemodialysis. Burkitt’s lymphoma intensive chemotherapy protocol was applied to our patient and treatment-related side effects (mucositis, myelosuppression, febrile neutropenia,…) were successfully treated. Our patient with stage IV diffuse bone marrow involvement was successfully treated and remission was achieved. The prognosis is good even in advanced disease with intensive treatment regimens in Burkitt lymphoma in childhood.5,12