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).