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Imaging Diagnosis

Burkitt's tumor in the soft tissues is avascular, and appears as a "solid" mass causing distortion within the organ itself and neighboring structures. In bone, it is a progressive osteolytic lesion.

Jaws and Facial Bones

The pattern of Burkitt's tumor in the jaws provides a good example which can be used to describe tumors in any part of the skeleton. It is essentially progressive and multifocal, and all the sequential changes may be seen at the same time in the same bone or in different parts of the skeleton. There may be a solitary small or large tumor or multiple tumors of varying sizes.

The first change in the jaw is the loss of the lamina dura surrounding the growing tooth; there may be no clinical swelling at this stage. There is destruction of the small trabeculae, resulting in clear, translucent areas. These give a mottled or moth-eaten appearance to the bone and, as individual foci spread throughout the mandible or maxilla, they coalesce until a gross tumor develops (Fig. 41.5). There will then be marked destruction of bone, reactive new bone, and periosteal proliferation. Multiple quadrants of the jaw may be involved, frequently all four at the same time: it is usual to see early changes in one area, and more advanced changes elsewhere. Soft tissue swelling develops as the osteolytic foci become confluent. Because of the soft tissue swelling and bone destruction, radiologically the teeth eventually appear to "float" and are displaced from their sockets. They seem quite loose, being lifted up by the radiolucent tumor. This dental displacement, sometimes called "dental anarchy" is characteristic: there are very few tumors in which the teeth seem to be so unrelated to the mandible or maxilla in which they are growing. Yet the teeth are perfectly normal and develop well without evidence of direct involvement.




Fig. 41.5A-G. Burkitt's lymphoma in the mandible. (A) "Dental anarchy". There is complete disruption of the normal dental pattern due to Burkitt's tumors in both the mandible and the maxilla. (B) The early stage of Burkitt's lymphoma in the mandible of the same patient. There is loss of lamina dura around the teeth, destruction of the small trabeculae, and a moth-eaten appearance which has already started to coalesce into a tumor. The teeth are beginning to "float" out of their sockets. (C) Bilateral Burkitt's tumors in the mandible. The teeth are "floating" and displaced in different directions. (D) Floating teeth: Burkitt's lymphoma is a common cause of this appearance. (E) A similar moth-eaten appereance in the mandible of another patient. The same changes occur in any bone in the early stage of Burkitt's lymphoma. (F) A tumor in the maxilla displacing the left side of the palate downwards and beginning to disrupt the teeth. (G) Maxillae of a Ugandan male child with Burkitt's lymphoma. The maxillae are swollen, the teeth are loosened, and the molars have fallen out. (C, D courtesy of Dr. W.E. Brant; G. courtesy of Dr. D.H. Connor).

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