چکیده
This article reports two cases of periradicular Burkitt’s lymphoma from Nigeria, to emphasize the difficulties in differentiating the early lesion from other periradicular lesions with similar clinical and radiological findings. Case 1, is a 4-year-old boy who presented with a one-month history of a painless, hard, posterior mandibular swelling (right), which was causing loosening and displacement of deciduous teeth (84 and 85). Histopathological examination of periradicular tissues from extracted tooth (85), confirmed the diagnosis of early periradicular Burkitt’s lymphoma. Case 2, is a 6-year-old boy who presented with one-week history of a loose, extruded right mandibular first molar tooth (46) and an exfoliated left mandibular first molar tooth (36). After two weeks of follow-up, the patient developed bilateral mandibular swelling at the molar region, as well as peri-orbital and bilateral pedal oedema. Incisional biopsy of the oral lesion at the region of exfoliated left first mandibular molar (36) was useful for histopathological diagnosis of early Burkitt’s lymphoma of the jaw. In the face of limited diagnostic tools such as clinico-radiological assessment, cytology or incisional biopsy for incipient periradicular lesions, a high index of suspicion of Burkitt’s lymphoma of the jaw may be helpful in early diagnosis and treatment of a lesion, presenting in a child as periradicular radiolucency or mixed radiolucency and radiopacity, with associated loosening and displacement of teeth.
Keywords: Periradicular, Burkitt’s lymphoma, Clinico-pathologic diagnosis.
Résumé
Cet article rapporte deux cas de lymphome de Burkitt péri radiculaire au Nigeria pour exprimer les difficultés à différentier les lésions précoces d’autres lésions périradiculaire ayant des résultats cliniques et radiologique semblable. Le premier cas chez un garçon de 4 ans ayant eu un mois d’un enflement du mandibule droit postérieur solide et sans douleur qui causait une perte et un déplacement des premières dents (84 et 85). L’examination histopathologique des tissues périradiculaire extrait des dents (85) confirmait le diagnostic du lymphome de Burkitt périradiculaire. Le deuxième cas d’un garçon de 6 ans avec un semaine d histoire de perte du premier molaire du mandibule droit (46). Après deux semaines de suivi, le patient developait un enflement bilatéral mandibulaire de la région molaire periorbitale et une oedeme pédale bilatérale. La biopsie incisionale de la lésion orale au niveau du premier mandibulaire gauche de la molaire etait utile pour le diagnosie histopathologique précose du lymphome de Burkitt de la joue. Avec les problèmes d’outils de diagnostic limités tels que l’évaluation clinique et radiologique, cytologique ou la biopsie incisionale pour les lésions périradiculaire, un indexe élevée de suspicion du lymphome de Burkitt de la joue peut être utile dans le diagnostic précoce et les soins de la lésion, présente chez un enfant comme radiolucence périradiculaire ou radiolucence mixée et radiopacite avec une perte et déplacement des dents.
Correspondence: Dr. F.O. Omoregie, Department of Oral and Maxillofacial Surgery and Pathology, University of Benin Teaching Hospital, Benin City, Nigeria. Email: omoregiefor@yahoo.com
مراجع
Mopsik ER and Milobsky SA. Malignant lymphoma presenting as periapical pathology: a report of two cases. MSDA J 1995; 38(4): 175-179.
Spatafore C M, Keyes G and Skidmore A E. Lymphoma: an unsual oral presentation. J Endod 1989; 15(9): 438-441.
Block RM, Mark HI and Bushell A. Metastatic carcinoma of the breast mimicking periapical disease in the mandible. J Endod.1977; 3(5):197-199.
Burkes E J. Jr. Adenoid cystic carcinoma of the mandible masquerading as periapical inflammation. J Endod. 1975; 1(2): 76-78.
Coonar H S. Primary intraosseous carcinoma of the maxilla. Br Dent J. 1979; 147(2): 47-48.
Copeland R R. Carcinoma of the antrum mimicking periapical pathology of pulpal origin: a case report. J Endod. 1980; 6(7):655-656.
Milobsky SA., Milobsky L and Epstein L I. Metastatic renal adenocarcinoma presenting as periapical pathosis in maxilla. Oral Surg Oral Med Oral Pathol. 1975; 39(1):30-33.
Nevins A, Ruben S, Pruden P and Kerpel S. Metastatic carcinoma of the mandible mimicking periapical lesion of endodontic origin. Endod Dent Traumatol. 1988; 45(5):238-239.
Spott R J. Metastatic breast carcinoma disguised as periapical disease in the maxilla. Oral Surg Oral Med Oral Pathol. 1985; 60(3):327-328.
Akinwande JA and Taiwo EO. Burkitt’s lymphoma of the Jaws: dental practice perspective. Nigerian Medical Practitioner. 1989; 17(5) 86-89.
Peters E and Monica L. Histopathologic examination to confirm diagnosis of periapical lesions: A review. J Can Dent Assoc. 2003; 69(9): 598-600.
Corcoran J E. The importance of periapical biopsy as a diagnostic tool in endodontics. J. Mich Dent. Assoc.1978; 60(10): 523-526.
Walton R E. Routine histopathologic examination of endodontic periradicular surgical specimens – is it warranted? Oral Surg Oral Med Oral Pathol Oral Radiol Endod.1998: 86(5):505.
Summerlin D J. Periapical biopsy or not. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999; 88(6): 645-646.
Kuc I, Pan J and Peters E. Use of histopathologic examination for periapical lesions by general dentists and specialists. American Academy of Oral and Maxillofacial Pathology Meeting, Dallas, Texas.1998.
Kuc I, Peters E and Pan J. Comparison of clinical and histologic diagnosis in periapical lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2000:89(3)333-337.
Wannsfors K and Hammarstrom I. Periapical lesions of mandibular bone: difficulties in early diagnostics. Oral Surg Oral Med Oral Pathol.1990; 70(4):483-489.
Ferry J A. Burkitt’s lymphoma: Clinicopathologic features and differential diagnosis. The Oncologist 2006; 11(4):375-383
Akinwande J A, Odukoya O, Nwoku A L and Taiwo E O. Burkitt’s lymphoma of the Jaws in Lagos: ten-year review. J Maxillofacial Surg. 1986; 14:323-28.
Fatusin OA, Akinwande JF and Durosinmi MA. Burkitt’s lymphoma In the Orofacial Region: Clinical and Radiological Findings- Experience in Ile-Ife, Nigeria. Nig Postgrad Med J. 1999; 6(2): 1-7.
Ramachandran N P N, Pajarola G and Schwede H E. Types and incidence of human periapical lesions obtained with extracted teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996; 81(1):93-102.
Newton C W. Biopsies necessary to meet standard care. J Endod.1999;25(3):211-212.
Wesiman M I. The importance of biopsy in Endodontics. Oral Surg Oral Med Oral Pathol.1975; 40(1): 153-154.
Tsui S H C, Wong M H and Lam W Y. Burkitt’s Lymphoma presenting as mandibular swelling- a report of a case and review of the literature. J Oral Maxillofac Surg. 2000; 38: 8-11.
Saheeb B D O, Onasanya P O and Omoregie F O. Early Burkitt’s lymphoma associated with dentigerous cyst: a case report. J Maxillofac Oral Surg, 2007; 6(4):82-84.
Ugar D A, Bozkaya S, Karaca I, Tokma B and Pinarli F G. Childhood Craniofacial Burkitt’s Lymphoma presenting as Maxillary Swelling: Report of a case and review of literature. J Dent Child 2006; 73: 45-50.
Lawal O O, Ojo O S and Durosinmi M A. Burkitt’s lymphoma in a 45 years old Nigerian woman. Trop Geogr Med.1990; 42: 294-297
Nkrumah P K and Olweny C I M. Clinical features of Burkitt’s lymphoma: The African experience in Burkitt’s lymphoma: Human cancer model (eds Lenoir G M, O’Conor G T, Olweny C I N) International Agency for Research on Cancer, IARC Scientific Publications, Lyon 1989; 60: 655-661
Kummoona R. Jaw lymphoma in Middle East children. B J Oral Surg.1977;115: 1153-1159.