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