Early Burkitt's Lymphoma Mimicking Dentigerous Cyst: A Case Report

Objective: To present a case of early Burkitt's lymphoma mimicking dentigerous cyst radiographically. Method: A 13 year old boy, presented to the oral surgery clinic, with a one week history of a swelling located posteriorly on the left mandible. The lesion was well circumscribed, bony hard, and measured about 4cm by 4cm. The overlying skin was intact, not warm, and freely mobile. All teeth except the third molars were present in both arches. Teeth 36 and 37 were mobile and displaced from the arch. Periapical radiograph showed periradicular radioluscency, with marked root resorbtion. Aspiration biopsy revealed blood tinged fluid aspirate. A tentative diagnosis of a cystic lesion was made.

Extraoral radiographs showed a well circumscribed radioluscent lesion at the angle of the left mandible encompassing an unerupted developing tooth 38, also involving teeth 37 and 36. Result:Radiologists reported the lesion to be a dentigerous cyst. The lesion was marsupialised, teeth 36 and 37 extracted with their periradicular tissues, and sent for histology. The histopathologist reported the lesion to be a ‘simple dental cyst'. Twelve days post operation, the site was filled with soft tissue and the acrylic bung placed earlier no longer fitted. The fleshy tissue subsequently over grew the operation site with presence of necrotic tissues, bleeding on manipulation, in addition to a submandibular swelling.

New radiographs and ultrasound reported ‘an osteolytic lesion of bone and a complex cystic / solid non-homogenous mass involving the left upper cervical and submandibular region, in addition to the lateral aspect of the submandibular gland'. A left superficial submandibular gland lobectomy and mandibulotomy was performed for the excisional biopsy of the lesion. Conclusion: Histopathology report of the biopsied tissues revealed it to be in keeping with Burkitt's lymphoma. Patient was referred immediately to the Paediatric Oncology Unit of the hospital.