title: Sporadic Burkitt Lymphoma Mimicking Osteomyelitis of the Mandible Revealing Clinically Unsuspected HIV Infection.
abstract: Adult sporadic Burkitt lymphoma is a rare and highly aggressive malignancy, accounting for approximately 1-2% of adult lymphomas in Western countries, and exclusively intra-oral localization is very uncommon. We describe a rare case of a moderately painful sporadic Burkitt lymphoma localized in the posterior third of the left mandibular bone, initially misdiagnosed as osteomyelitis-like lesion, in a patient Epstein-Barr virus infection-negative with unknown human immunodeficiency virus (HIV) positivity and acquired immunodeficiency syndrome. A 52-year-old man was referred to our Department complaining of persistent moderate pain localized in the left mandibular arch. According to clinical and radiological features, a diagnosis of post-extraction osteomyelitis was made and a surgical revision, including soft and hard tissue biopsy, was performed. Histopathology revealed the presence of a diffuse proliferation of lymphoid cells, exhibiting the typical 'starry-sky' appearance that was consistent with the diagnosis of B-type non-Hodgkin lymphoma. Unexpectedly, HIV seropositivity was also found, but the patient was unaware of this, and the history did not reveal any particular risk factor for HIV infection. Positron-emission tomography showed a highly (18)F-fluorodeoxyglucose-avid mass in the left maxillofacial region and extensive disease in bone marrow and mediastinum. Thus, the patient was referred to our onco-hematological team for final assessment and care. In conclusion, sporadic Burkitt lymphoma is an aggressive malignancy, which rarely affects adults with initial intra-oral manifestations. In the presence of abnormal gingival or alveolar lesions, a non-odontogenic disease should be suspected and the appropriate diagnostic test should be performed.
authors.affiliation: Department of Neurosciences, University of Padua, School of Medicine, Padova, Italy stefano.sivolella@libero.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Sivolella
authors.affiliation: Department of Neurosciences, University of Padua, School of Medicine, Padova, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Rizzo
authors.affiliation: Department of Cardiologic Thoracic and Vascular Sciences, University of Padua, School of Medicine, Padova, Italy.
authors.forename: Marialuisa
authors.initials: M
authors.lastname: Valente
authors.affiliation: Department of Surgery Oncology and Gastroenterology, University of Padua, School of Medicine, Padova, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Lumachi
mesh_terms: D002051:Burkitt Lymphoma / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D019788:Fluorodeoxyglucose F18; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008334:Mandible / Q000000981:diagnostic imaging / Q000473:pathology*; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: Burkitt lymphoma; EBV; Epstein-Bar; FDG-PET; HIV infection; mandible; non-Hodgkin lymphoma; osteomyelitis