Primary Cervical Burkitt's lymphoma masquerading tuberculous adenitis: a case report and review of the literature

Abstract

Burkitt's lymphoma (BL) is the most highly aggressive and rapidly growing tumour ever known in humans that appears to occur in three histologically and phenotypically identical but clinically distinct forms; endemic, sporadic and the immunodeficiency-associated variant. There is considerable overlap among these distinct variants. The endemic form is most commonly observed in equatorial Africa, in children aged 4-7 years, with frequent involvement of the mandible and facial bones. In contrast, in other geographic regions, most patients present with abdominal tumours and have no specific geographic or climatic distribution.  An 8-year-old Negro boy presented with swelling on the right side of the neck for three weeks, with a progressive increase in size. He had drenching night sweat, but no associated fever. No history was suggestive of congenital immunodeficiency syndrome. Examination of the neck revealed right-sided cervical lymphadenopathy that was firm and matted, not tender, nor other features of inflammation. Histology showed nodal architecture that was effaced by malignant lymphoid neoplasm with prominent nucleoli and scanty cytoplasm, as well as brisk mitotic activity with numerous macrophages in an inflammatory background. The immuno-histochemical profile of the tumour was CD20 and CD10 positive with BCl-2 and CD15 negative. Human immunodeficiency virus serology was negative. Burkitt’s lymphoma arising exclusively from lymph nodes may mimic tuberculous adenitis while a potentially curable tumour, with cautious use of appropriate combination chemotherapy, its treatment is quite distinct from that of tuberculosis. Cheaper generic formulation are readily available. It is conceivable to conclude that with efficient supportive therapy, BL is no longer life-threatening cancer in children.