Sporadic Burkitt's lymphoma of the parapharyngeal space in an immunocompetent adult Indian male

Abstract

A 17 year old male presented with one month history of difficulty in swallowing, reduced hearing with intermittent pain in right ear, occasional nasal bleeding; slurring of speech and occasional headache with a few episodes of fainting. Clinical examination revealed right hypoglossal nerve palsy, and right lateral pharyngeal wall and tonsil were displaced medially. Right serous otitis media along with ipsilateral cervical and axillary lymphadenopathy were present. Blood biochemistry and urine examination were normal. An irregular heterogenous-enhancing mass in the right parapharyngeal space encasing the internal and external carotid arteries was evident on CT. Bone marrow biopsy was free from lymphomatous involvement. biopsy from the nasopharyngeal bulge was consistent with a submucosal malignant round cell tumour. Immunohistochemistry showed tumour cells which were CD20 and CD22 positive, and negative for CD5, Desmin, Cytokeratin (CK), CD99, and synaptophysin; with a proliferative fraction (Ki-67 index) of greater than 98%. A diagnosis of Burkitt's lymphoma of the parapharyngeal space, stage II E was made. Patient responded to chemotherapy. Sporadic Burkitt's lymphoma in an immunocompetent Indian male is being reported because of its unusual location-parapharyngeal space. Copyright © 2014, Indian Journal of Medical Specialities. Published by Reed Elsevier India Pvt. Ltd. All rights reserved.