Arzu OKUR1, Özge VURAL1,
Ümit Özgür AKDEMİR2, Faruk Güçlü
PINARLI1
1Gazi University Faculty of Medicine, Department of
Pediatric Oncology, Ankara, Türkiye
2Gazi University Faculty of Medicine, Department of
Nuclear Medicine, Ankara, Türkiye
Abstract: Burkitt and Burkitt-like lymphomas constitute 40% of
childhood lymphomas and are malignancies that require urgent diagnosis
and treatment. Here, we present a case of a 10-year-old male patient who
was diagnosed with Burkitt lymphoma and applied to the dentist with
complaints of pain in the left upper molars and facial swelling for 2
weeks. Magnetic resonance imaging showed significant soft tissue
swelling around the mandible and maxillary tooth roots in the lower and
upper jaws. The patient was diagnosed with Burkitt lymphoma in the
histopathological examination of the gingival biopsy. Diffuse bone
marrow involvement and hyperuricemia due to tumor lysis syndrome were
detected in this pediatric patient. The patient with stage IV Burkitt
lymphoma has been successfully treated with intensive chemotherapy
protocols and has been in remission for 5 years. Burkitt lymphoma should
be considered in the differential diagnosis of soft tissue swellings in
the jaw and orofacial region presenting with dental pain in childhood.
Key Words: Burkitt lymphoma, childhood cancer, dental pain
İntroduction: Burkitt lymphoma, a subtype of non-Hodgkin
lymphoma, is a malignancy that needs urgent diagnosis and treatment due
to its high grade and growth rate in childhood. It is classified as
endemic, sporadic, and immunodeficiency-related.1,2Disseminated disease, high tumor burden, and renal involvement can cause
tumor lysis syndrome and can even result in death in patients with
Burkitt lymphoma.3,4,5 A boy child patient who applied
to the dentist with facial swelling following toothache is presented
here.
Case Report: A 10-year-old male patient applied to the dentist
with complaints of pain in the left maxillary molars teeth and swelling
on his face for 2 weeks. Tooth extraction was not performed and oral
antibiotic treatment was started considering infection. Due to the
swelling progressing toward the lower eyelid, a biopsy was taken from
the gingival swelling, and the patient was quickly referred to our
center. On physical examination, there was diffuse facial edema and
swelling, and painless lymphadenopathies of 2x2cm were palpated in the
bilateral upper cervical region. The child’s past medical history was
non-specific. The patient did not have any associated immunodeficiency
and infectious agents (Epstein–Barr viruses and HIV) were negative.
Hemogram and peripheral smear were normal. Although the biochemical
values of potassium, phosphorus, urea, and creatine were within normal
values, uric acid (8.0 mg/dl, normal: 3.5-6.5) and lactate dehydrogenase
(LDH) (1710 mg/dl, normal: 150-350) levels were elevated in the patient.
Magnetic resonance imaging (MRI) showed significant soft tissue swelling
around the mandible and maxillary tooth roots in the lower and upper
jaws (Fig.1A, B).
The patient was diagnosed with Burkitt lymphoma in the histopathological
examination of the gingival biopsy. Histologically, there was a ‘starry
sky’ appearance with cell morphology and immunohistochemical staining
was diffusely positive for CD20, bcl-6, and CD10, and ki-67 staining was
positive in more than 100% of the monomorphic neoplastic lymphoid cells
in biopsy tissue. Imaging method performed for staging, whole-body
positron emission tomography (PET)/MRI revealed hypermetabolic activity
in soft tissue swelling around the mandible and maxillary,
retroperitoneal lymph nodes, both kidneys, and diffuse bone marrow
involvement (Fig.2 C, D, and E).