Oro-facial manifestations of Burkitt's lymphoma: an analysis of 680 cases from Malawi.

Burkitt's lymphoma (BL) is a highly aggressive, fast growing, mature B-cell non-Hodgkin's Lymphoma (NHL) and has one of the highest proliferation rates of any human tumour. There are three forms of BL: endemic or the African form (eBL), sporadic or non-endemic form (sBL) and the immunodeficiency-associated form in HIV-AIDS. The survival rate of a child with BL is dependent upon rapid diagnosis and treatment. The aim of the present study was to determine the oro-facial manifestations in children with BL in Malawi. It was carried out in two parts: the first, a retrospective record-based study (2005-2007) consisting of 661 cases of BL and the second, a prospective study (June 2008 -October 2009) documenting 19 cases of suspected and confirmed cases of BL. In the retrospective study, two thirds presented with BL at various sites of which the abdomen was the most common site. The 5-9 year age group predominated with an average peak incidence of 7 years and accounted for 60.0% of all the cases. There was a male preponderance with a ratio of male to female of 1.6:1. The maxilla was the most common site for oro-facial BL (13.7%) followed by the mandible (7.2%), cheeks (5.7%), maxilla and mandible (4.5%) and cervical lymph nodes (4.1%). Of the 397 with BL, 41.4% were tested for HIV and 37.97% were HIV-negative while 5% were HIV-positive. In the prospective study, females predominated with a male to female ratio of 1.1:1 and the mandible was the most common site accounting for 19.04%. The age group 5-9 years predominated with 68.4% relative frequency. Generally the trend of BL had decreased from 2005 to 2007 possibly due to better access to health services, increased use of bed-treated mosquito nets for malaria prevention and knowledgeable healthcare workers. All oral healthcare and other healthcare workers need to be educated on the oro-facial manifestations of BL for prompt referral and management. This would result in a better prognosis since BL is curable as it responds favourably to chemotherapy. Furthermore, communities need to be educated on the early signs and symptoms of BL and the importance of visiting a hospital as soon as possible.