Unique Pathogenesis of Burkitt’s Lymphoma with Presentation in the Nasopharynx

Nova Southeastern University, Davie, Florida, USA

Introduction Epstein-Barr Virus (EBV) is a known causative agent for B-cell hyperplasia, and has a significant role in the pathogenesis of the aggressive B cell-derived Burkitt’s Lymphoma (BL). Typical locations for primary BL tumors include the face, kidneys, reproductive organs, gastrointestinal organs, and meninges. However, BL development is complex and does not always occur in predictable patterns. Case Presentation The present case describes a 72-year-old Caucasian female who presented with a sore throat, cough, left ear pain and hearing loss. Initial examination revealed serous fluid in the left middle ear, and nasopharyngoscopy showed prominent tissue present in the nasopharynx with overlying thickened mucus and dried blood. CT scan was completed and forwarded to radiology for review. A biopsy was obtained, and samples were analyzed with histology and flow cytometry. Tissue findings were consistent with BL and were negative for EBV. Deviation From the Expected The present case describes an atypical pathogenesis and presentation of BL, which is not well documented in the scientific literature. Discussion EBV is present in 95% of BL cases. Furthermore, lymphomas of adulthood (mean age of onset of 30-50 years) account for only one percent of all BL cases, whereas childhood lymphomas (mean age of onset 5-10 years) account for 30% of cases. Our patient outlies both of these normative BL conditions. Equally important to note is the location of our patient’s tumor; the nasopharyngeal space is not a common site for BL and, in fact, nasopharyngeal BL accounts for less than 23% of all Non-Hodgkin lymphoma cases. Conclusion Although one similar EBV-negative case has been described, to our knowledge this is the first reported case of an older Caucasian female with EBV-negative nasopharyngeal BL.