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| Year : 2011 | Volume
: 54
| Issue : 3 | Page : 667-668 |
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| Classical Burkitt's lymphoma |
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R Sudhakara Reddy1, R Lavanya2, M Ravikanth3, T Ramesh1, Tenny John1, T Rajesh Singh1
1 Department of Oral Medicine and Radiology, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
2 Post Graduate Student, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
3 Department of Oral Pathology, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
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| Date of Web Publication | 20-Sep-2011 |
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How to cite this article:
Reddy R S, Lavanya R, Ravikanth M, Ramesh T, John T, Singh T R. Classical Burkitt's lymphoma. Indian J Pathol Microbiol 2011;54:667-8 |
Sir,
Even though Burkitt's lymphoma is a rare, progressive malignant tumor frequently associated with human immune deficiency virus (HIV)-infected individuals, its occurrence is highlighted as one of the earliest clinical manifestations. Early diagnosis with appropriate treatment can prevent disease progression. We came across a case of Burkitt's lymphoma in a 36-year-old female patient with complaint of growth in the lower anterior teeth region since 2 months. Initially starting as a small size, this gradually increased and attained the size of 5 cm × 4.5 cm, associated with the loss of lower anterior teeth, bleeding, dysphagia and no pain.
Past medical, family and personal history were noncontributory. General physical examination revealed moderate built and ill nourished. On extraoral examination, facial asymmetry was observed and regional and cervical group of lymph nodes were not palpable.
On intraoral examination, oral hygiene status was poor and there were multiple root stumps. Soft tissue examination revealed a solitary multinodular/lobulated growth in the mandibular anterior teeth region extending from the labial vestibule involving the alveolar ridge and the floor of the mouth in the anterioposterior direction, mediolaterally from the right premolar to the left premolar, measuring 5 cm × 4.5 cm in size with irregular shape. The color of the growth varied in different regions, ranging from pale pink to reddish brown. The surface over the growth was smooth, with white slough [Figure 1]. On palpation, the growth was firm in consistency, fixed to the underlying structure, nontender and bleeding on palpation. | Figure 1: A solitary multi nodular/lobulated growth in the mandibular anterior teeth region extending from the labial vestibule involving the alveolar ridge to the fl oor of the mouth, measuring 5 cm × 4.5 cm in size, with irregular shape. The color of the growth varied in diff erent regions, ranging from pale pink to reddish brown
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In this case, the growth was present in the mandibular anterior region, extending from the labial vestibule to the floor of the mouth. Posterior segments of the jaws are more commonly affected; maxilla is involved more commonly than mandible. [1],[2]
Oral signs in this case include missing lower central incisors and mobility of adjacent teeth. Burkitt's lymphoma is one of the most rapidly growing tumors, doubling in size for every 24 h. [3] When Burkitt's lymphoma with extranodal head and neck involvement is the presenting sign, it is usually first diagnosed by the dentist. Unfortunately, the tumor initially was diagnosed clinically as a variant of squamous cell carcinoma with poor prognosis or rapidly growing jaw tumor.
History and clinical examination were suggestive of a malignant neoplasm arising from the alveolar ridge of the mandible involving the floor of the mouth. A differential diagnosis of nodular variant squamous cell carcinoma, Burkitt's lymphoma, fibrosarcoma and osteosarcoma were considered. [1],[4]
Panoramic radiograph showed an ill-defined, noncorticated radiolucency in the mandibular anterior teeth regions with loss of teeth in relation to mandibular central incisors and left lateral incisor. Routine investigations were normal, except that antibodies for HIV were found to be positive.
Incisional biopsy was performed with special care. Histological examination of the biopsy specimen revealed a diffuse monomorphous population of medium-sized lymphocytes with round to oval nuclei, prominent basophilic nucleoli, coarse chromatin and a thick nuclear membrane, abundant mitotic figures and tingible -body macrophages, giving the classic "starry-sky" appearance [Figure 2]. | Figure 2: Connective tissue exhibiting sheets of neoplastic lymphocytes intermixed with histiocytes giving the appearance of a starry-sky appearance. Neoplastic lymphocytes with round nuclei coarse chromatin and multiple basophilic nucleoli with tingle body macrophages. Hematoxilin and eosin stain with ×40 magnification
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Diagnosis of Burkitt's lymphoma was considered based on the clinical, radiographic and histological investigations. The patient was reffered to a regional oncology center for futher management, but succummed to the disease in less than 3 months.
 References | |  |
| 1. | Ferry JA. Burkitt's Lymphoma: Clinicopathologic Features and Differential Diagnosis. Oncologist 2006;11:375-83. 
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| 2. | Regezi JA, Sciubba JJ, Jordan RC, editors. Oral Pathology. Clinical pathological correlations. Missouri: Elsevier; 2003.
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| 3. | Pramanik R, Prarl CC, Ghosh A. Pattern of solid malignant tumours in children-a ten year study. J Indian Med Assoc 1997;95:107-8.
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| 4. | Boerma EG, van Imhoff GW, Appel IM, Veeger NJ, Kluin PM, Kluin- Nelemans JC. Gender and age-related differences in Burkitt lymphoma epidemiological and clinical data from The Netherlands. Eur J Cancer 2004;40:2781-7.
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Correspondence Address:
R Sudhakara Reddy
Department of Oral Medicine and Radiology, Vishnu Dental College, Vishnupur, Kovada, Bhimavaram - 534 202, West Godavari District, Andhra Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0377-4929.85151
[Figure 1], [Figure 2] |
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