Burkitt Lymphoma Presentation with Oropharyngeal Mass of Tonsillar Fossa: A Case Report

TL;DR

This case report describes a rare presentation of Burkitt lymphoma in a child as an oropharyngeal mass, emphasizing the importance of early diagnosis and treatment.

Contribution

The novelty lies in highlighting a rare clinical presentation of Burkitt lymphoma in a pediatric patient with tonsillar swelling.

Findings

Burkitt lymphoma was diagnosed in an 8-year-old male presenting with tonsillar swelling and oral bleeding.

Imaging and biopsy confirmed a bulky oropharyngeal mass with c-MYC positivity and 'starry sky' appearance.

The case emphasizes the need to consider Burkitt lymphoma in the differential diagnosis of pediatric neck masses.

Abstract

Burkitt lymphoma is a highly aggressive subtype of non-Hodgkin lymphoma with varied clinical presentation, including in some cases involvement of the intraoral cavity. Early recognition of this malignancy is critical, as it typically responds well to prompt and intensive treatment. In this case report, we present a rare manifestation of Burkitt lymphoma presenting as an oropharyngeal mass.

An eight-year-old male presented with tonsillar swelling and new-onset oral bleeding. A month earlier, he had been seen in the emergency department (ED) for similar swelling following a streptococcal infection. At that time, a needle aspiration for suspected peritonsillar abscess yielded no drainage, and he was treated with a week of clindamycin, resulting in brief symptom improvement. He subsequently developed difficulty breathing, a muffled voice, and oral bleeding, prompting a return to the ED. On evaluation, he was afebrile, well-appearing, and in no respiratory distress. Examination revealed significant left tonsillar swelling with uvular deviation but no active bleeding. Magnetic resonance imaging demonstrated a bulky left oropharyngeal mass with airway narrowing, raising suspicion for lymphoma. Laboratory results were unremarkable, and biopsy confirmed Burkitt lymphoma based on c-MYC positivity and the characteristic “starry sky” appearance, leading to the initiation of chemotherapy.

Burkitt lymphoma is a high-grade lymphoma with a large tumor burden and, thus, high risk for tumor lysis syndrome. Fortunately, Burkitt lymphoma has superior survival outcomes in pediatrics with a two-year survival rate estimated to be 89% and requiring minimal cycles of chemotherapy. This case underscores the diverse presentations of Burkitt lymphoma and the importance of including it in the differential for all pediatric neck masses, regardless of demographics.

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