Orbital Burkitt's Lymphoma: An Aggressive Presentation

Primary lacrimal sac Burkitt lymphoma: A case report and literature review

Purpose

To highlight a case report of high-grade primary lacrimal sac Burkitt lymphoma in a young adult.

Observation

A 25-year-old gentleman was referred to the oculoplastic center for left eye medial canthal progressive swelling at the level below the medial canthal tendon for two months associated with tearing. He was initially treated for preseptal cellulitis but failed to respond to antibiotics. Both eyes vision were 6/9, and the ocular examination showed a left medial canthal non-tender, firm mass 2cm by 3 cm in size, immobile, smooth surface, and inflamed overlying skin. Otherwise, both anterior segment and fundus examinations were unremarkable. Contrasted CT orbit revealed a 3cm enhanced lesion around the lacrimal system region with extension into the middle nasal hiatus and maxillary bone destruction. Left incisional biopsy and tumor debulking were done. Intraoperative findings were a whitish, firm mass with bony destruction at the left maxillary bone. Histopathological examination showed high-grade B cell lymphoma and areas of starry-sky appearance. Immunological markers (CD20, CD79a, CD10, MUM1, BCL6, and BCL2) were positive. Left nasolacrimal sac Burkitt lymphoma diagnosis was made, and CT-thorax-abdomen-pelvis reported no distant metastasis. The patient was referred to a haemato-oncologist and completed six cycles of R-block chemotherapy. The patient is currently in complete remission at six months.

Conclusions and Importance

Lacrimal sac Burkitt lymphoma can occur in young, healthy adults; however, a high index of suspicion is mandatory in young patients with preseptal cellulitis associated with medial canthal swelling and recurrent acute dacryocystitis.

A B-cell lymphoma case that is unclassifiable, and intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma of lacrimal gland

A 60-year-old woman presented with acute eyelid swelling and a subcutaneous hemorrhage in the right eye. Magnetic resonance imaging showed a spherical tumor of the lacrimal gland. The tumor was removed by the Kroenlein method. We diagnosed as a B-cell lymphoma that is unclassifiable, and intermediate between diffuse large B-cell lymphoma (DLBCL) and Burkitt lymphoma (BL) (intermediate DLBCL/BL) based on its immunohistopathological examination and c-MYC/IgH rearrangement. We administered six cycles of dose-adjusted-EPOCH-R (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin hydrochloride, and rituximab) therapy, and remission of the lymphoma was obtained. This is the first case of an intermediate DLBCL/BL of a lacrimal gland.

Primary sporadic Burkitt lymphoma of the orbit, clinical characteristics, management, and outcomes: a case study

BACKGROUND

Involvement of the orbit with Burkitt's lymphoma is a very rare presentation of extra-nodal lymphoma.

ILLUSTRATIVE CASE

We report a case of a 2-year-old female presented an unusual location of sporadic Burkitt's lymphoma arising in the orbital region. Diagnostic magnetic resonance imagining identified an oval-shaped mass on the lateral rectus of the right orbit that caused dislocation of eyeball, for which she underwent a biopsy from the periorbital swellings. The mass was histologically confirmed as Burkitt's lymphoma, and postoperative aggressive chemotherapy was initiated. We describe clinical diagnosis, histological aspects, radiological features, and current management of this rapidly growing malignant tumor.

CONCLUSION

Because of the rapid progression of Burkitt lymphoma, and considering that it responds well to treatment, early recognition and appropriate management are important factors for survival and to preserve visual function.

Recurrent Immunodeficiency-Associated Burkitt Lymphoma Presenting as Severe Anterior Uveitis

PURPOSE

To report a case of recurrent immunodeficiency-associated Burkitt lymphoma (BL) that initially presented as severe anterior uveitis.

METHODS

Case report.

RESULTS

To our knowledge, this is the first reported case of isolated anterior uveitis related to immunodeficiency-associated BL. A 34-year-old African American woman with a history of HIV and BL in remission presented with unilateral anterior uveitis. Histopathologic study of an aqueous humor specimen was consistent for BL.

CONCLUSION

The patient's initial presentation masqueraded as anterior uveitis, but her condition rapidly progressed with significant central nervous system involvement. Ocular involvement of immunodeficiency-associated BL is rare, with isolated anterior uveitis being even rarer. This must be kept in mind in the differential diagnosis for any patient with immunodeficiency, especially with a history of previous BL.

Maxillary sporadic Burkitt's lymphoma associated with neuro-orbital involvement in an Indian male

Burkitt's lymphoma (BL) is the fastest growing malignancy of the lymphoreticular system to affect humans and has a potential ability to double in size every day. A case of maxillary sporadic BL (sBL) associated with neuro-orbital involvement in an Indian male is presented. sBL initially presented as maxillary swelling with no obvious dental and periodontal changes. Histological specimen from incisional biopsy revealed a round cell malignant tumor and immunohistochemistry reactions favored nonHodgkin's lymphoma consistent with BL. Four weeks later, patient presented with orbital involvement as diplopia, sixth cranial nerve palsy, and medial rectus palsy. Chemotherapy regimen according to LMB 89 protocol was started. During chemotherapy regimen patient showed bradycardia and Babinski response, suggestive of central nervous system involvement. sBL associated with orbital involvement is extremely rare and only seven cases have been reported. Our case showed unusual presentation; despite the aggressive tumor did not show any common clinical, radiological, and hematological findings. We also discussed the role of oral medicine specialist, importance of early diagnosis, and prompt referral in management of maxillary sBL.