Journal of the korean academy of Pediatric Dentistry (대한소아치과학회지)

Korean Academy of Pediatric Dentistry (대한소아치과학회)
권호 표지
DOI QR코드

DOI QR Code

Early Diagnosis of Burkitt Lymphoma on the Mandible: A Case Report

하악골에서 발생한 Burkitt 림프종의 조기발견과 진단

  • Kim, Miae (Division of Pediatric Dentistry, Department of Dentistry, Ewha Womans University Mokdong Hospital) ;
  • Park, Jihyun (Division of Pediatric Dentistry, Department of Dentistry, Ewha Womans University Mokdong Hospital) ;
  • Mah, Yonjoo (Division of Pediatric Dentistry, Department of Dentistry, Ewha Womans University Mokdong Hospital)
  • 김미애 (이화여자대학교 의과대학 목동병원 소아치과학교실) ;
  • 박지현 (이화여자대학교 의과대학 목동병원 소아치과학교실) ;
  • 마연주 (이화여자대학교 의과대학 목동병원 소아치과학교실)
  • Received : 2015.06.08
  • Accepted : 2015.08.31
  • Published : 2016.11.30
Download PDF
⟨ Previous Next ⟩

Abstract

Burkitt lymphoma (BL) is an aggressive form of non-Hodgkin's B-cell lymphoma found primarily in the pediatric population. In the oral cavity, this tumor can grow rapidly and often brings about facial swelling or development of an exophytic mass involving the jaws. A 5-year-old boy was referred for swelling and pain in the left mandibular area. The patient showed diffuse swelling on the left side of the mandible and firm-moderate tenderness upon palpation. An intraoral examination showed moderate mobility and sensitivity to percussion on the left primary first and second molars, without severe caries. A radiographic examination revealed complete loss of the lamina dura on the left primary second molar and permanent first molar. There was a radiolucent osteolytic lesion and destruction of the cortical bone of the left mandibular body. Based on the clinical, radiographic, and immunohistochemical findings, the patient was diagnosed with BL, and was referred to a pediatrician for systemic evaluation and intensive chemotherapy. Even before the completion of chemotherapy, the swelling resolved and the displaced teeth were relocated to a normal position. This patient showed a good prognosis due to prompt diagnosis and intensive chemotherapy. Early diagnosis and referral for treatment can prevent the development of BL.

Burkitt 림프종은 소아에서 호발하는 악성 종양의 하나로 non-Hodgkin B 림프종의 한 형태이다. 매우 빠르게 증식하는 종양으로 구강 내에서 발생시 안면부 부종 및 이환 치아의 동요도와 변위, 치은의 발적 및 부종 등의 증상을 보인다. 본 증례는 5세 남환으로 왼쪽 하악부의 통증과 안면부 부종으로 개인병원에서 의뢰되었다. 왼쪽 하악골부터 관골까지 퍼진 안면부 부종을 보였으며 좌측 하악 유구치는 심한 충치가 없음에도 불구하고 중등도의 동요도를 보이고 타진에 양성 반응을 보였다. 방사선학적 소견으로는 좌측 하악 제2유구치와 제1영구치의 치조 백선 소실이 관찰 되었으며, 좌측 하악골에는 방사선 투과성의 골용해성 소견과 피질골의 파괴가 관찰되었다. 환아는 임상적, 방사선학적, 면역조직학적 검사를 바탕으로 Burkitt 림프종으로 진단되었고, 전신적인 검사와 항암 화학요법을 위해 본원 소아과로 의뢰되었다. 화학요법을 시작한 지 3개월만에 안면부 및 치은의 부종이 소실되었고, 치아의 동요도 및 위치도 정상으로 회복되었다. Burkitt 림프종으로 진단된 본 환아는 조기 진단과 집중적인 화학요법으로 좋은 예후를 보였기에 이를 보고하는 바이다.

Keywords

References

  1. Burkitt D : A sarcoma involving the jaws in African children. Br J Surg, 46:218-223, 1958. https://doi.org/10.1002/bjs.18004619704
  2. Shapira J, Peylan-Ramu N : Burkitt's lymphoma. Oral Oncol, 34:15-23, 1998. https://doi.org/10.1016/S1368-8375(97)00041-9
  3. Sandlund JT, Downing JR, Crist WM : Non-Hodgkin's lymphoma in childhood. N Engl J Med, 334:1238-1248, 1996. https://doi.org/10.1056/NEJM199605093341906
  4. Ardekian L, Rachmiel A, Rosen D, et al. : Burkitt's lymphoma of the oral cavity in Israel. J Craniomaxillofac Surg, 27:294-297, 1999. https://doi.org/10.1054/jcms.1999.0074
  5. Link MP, Donaldson SS, Berard CW, et al. : Results of treatment of childhood localized non-Hodgkin's lymphoma with combination chemotherapy with or without radiotherapy. N Engl J Med, 322:1169-1174, 1990. https://doi.org/10.1056/NEJM199004263221701
  6. Iversen OH, Iversen U, Ziegler JL, Bluming AZ : Cell kinetics in Burkitt lymphoma. Eur J Cancer, 10:155-163, 1974. https://doi.org/10.1016/0014-2964(74)90148-0
  7. Burkitt D, Wright D : Geographical and tribal distribution of the African lymphoma in Uganda. Br Med J, 1:569-573, 1966. https://doi.org/10.1136/bmj.1.5487.569
  8. Epstein MA, Achong BG, Barr YM : Virus Particles in Cultured Lymphoblasts from Burkitt's Lymphoma. Lancet, 1:702-703, 1964.
  9. Tao Q, Robertson KD, Manns A, et al. : Epstein-Barr virus (EBV) in endemic Burkitt's lymphoma: molecular analysis of primary tumor tissue. Blood, 91:1373-1381, 1998.
  10. Evans AS : Epidemiology of Burkitt's lymphoma: other risk factors. IARC Sci Publ, 60:197-204, 1985.
  11. Pannone G, Zamparese R, Pace M, et al. : The role of EBV in the pathogenesis of Burkitt's Lymphoma: an Italian hospital based survey. Infect Agent Cancer, 9:34, 2014. https://doi.org/10.1186/1750-9378-9-34
  12. Beral V, Peterman T, Berkelman R, Jaffe H : AIDSassociated non-Hodgkin lymphoma. Lancet, 337:805-809, 1991. https://doi.org/10.1016/0140-6736(91)92513-2
  13. Jan A, Vora K, Sandor GK : Sporadic Burkitt's lymphoma of the jaws: the essentials of prompt life-saving referral and management. J Can Dent Assoc, 71:165-168, 2005.
  14. Tsui SH, Wong MH, Lam WY : Burkitt's lymphoma presenting as mandibular swelling--report of a case and review of publications. Br J Oral Maxillofac Surg, 38:8-11, 2000. https://doi.org/10.1054/bjom.1999.0358
  15. Lee SE, Sohn MY, Choi SC, et al. : Burkitt's lymphoma of the Mandible in a Child. J Korean Acad Pediatr Dent, 39:79-83, 2012. https://doi.org/10.5933/JKAPD.2012.39.1.79
  16. Ardekian L, Peleg M, Samet N, et al. : Burkitt's lymphoma mimicking an acute dentoalveolar abscess. J Endod, 22:697-698, 1996. https://doi.org/10.1016/S0099-2399(96)80068-9
  17. Lund DI, Rodd H, Craig GT : Burkitt's lymphoma presenting with jaw lesions in a young white girl. Br J Oral Maxillofac Surg, 35:438-441, 1997. https://doi.org/10.1016/S0266-4356(97)90723-3
  18. O'Malley DP, Auerbach A, Weiss LM : Practical Applications in Immunohistochemistry: Evaluation of Diffuse Large B-Cell Lymphoma and Related Large B-Cell Lymphomas. Arch Pathol Lab Med, 2015.
  19. Sariban E, Donahue A, Magrath IT : Jaw involvement in American Burkitt's Lymphoma. Cancer, 53:1777-1782, 1984. https://doi.org/10.1002/1097-0142(19840415)53:8<1777::AID-CNCR2820530828>3.0.CO;2-7
  20. Banthia V, Jen A, Kacker A : Sporadic Burkitt's lymphoma of the head and neck in the pediatric population. Int J Pediatr Otorhinolaryngol, 67:59-65, 2003. https://doi.org/10.1016/S0165-5876(02)00283-5
  21. Ferry JA : Burkitt's lymphoma: clinicopathologic features and differential diagnosis. Oncologist, 11:375-383, 2006. https://doi.org/10.1634/theoncologist.11-4-375
  22. Appelbaum FR, Deisseroth AB, Graw RG Jr, et al. : Prolonged complete remission following high dose chemotherapy of Burkitt's lymphoma in relapse. Cancer, 41:1059-1063, 1978. https://doi.org/10.1002/1097-0142(197803)41:3<1059::AID-CNCR2820410339>3.0.CO;2-N
  23. Nkrumah FK, Perkins IV : Relapse in Burkitt's lymphoma. Int J Cancer, 17:455-460, 1976. https://doi.org/10.1002/ijc.2910170407
  24. Philip A. Pizzo DGP : Principle and practice of pediatric oncology, 3rd ed. Lippincott-Raven Publishers, 545-587, 1997.
  25. Holtta P, Alaluusua S, Saarinen-Pihkala UM, et al.: Long-term adverse effects on dentition in children with poor-risk neuroblastoma treated with high-dose chemotherapy and autologous stem cell transplantation with or without total body irradiation. Bone Marrow Transplant, 29:121-127, 2002. https://doi.org/10.1038/sj.bmt.1703330
  26. Kim SK, Kim MJ, Jeong TS, et al. : Management of oral complications in the pediatric population with cancer. J Korean Acad Pediatr Dent, 36:157-167, 2009.
  27. Gawade PL, Hudson MM, Kaste SC, et al.: A systematic review of dental late effects in survivors of childhood cancer. Pediatr Blood Cancer, 61:407-416, 2014. https://doi.org/10.1002/pbc.24842
  28. Otmani N, Khattab M : Oral Burkitt's lymphoma in children: the Moroccan experience. Int J Oral Maxillofac Surg, 37:36-40, 2008. https://doi.org/10.1016/j.ijom.2007.06.010
  29. Murphy SB, Fairclough DL, Hutchison RE, Berard CW : Non-Hodgkin's lymphomas of childhood: an analysis of the histology, staging, and response to treatment of 338 cases at a single institution. J Clin Oncol, 7:186-193, 1989. https://doi.org/10.1200/JCO.1989.7.2.186