ABSTRACT
Burkitt's lymphoma is not an uncommon malignancy in the paediatric population. It is a high-grade non-Hodgkin B-cell lymphoma which may present as endemic, sporadic and human immunodeficiency-associated subtypes. The African, or endemic, variant usually involves the maxilla and other facial bones while head and neck manifestations in sporadic Burkitt's lymphoma are rare. We described a case of oral Burkitt's lymphoma involving the right jaw in a 4-year-old boy. The patient presented with a rapidly-enlarging swelling of one month duration, toothache-like pain and radiographical appearance of 'floating teeth' in the right mandible. Incisional biopsy revealed small round tumour cells with scarce cytoplasm and multiple small nuclei interspersed by phagocytic macrophages. The tumour cells were immunopositivity for CD20 and CD10, expressed weak positivity for CD3, negative for CD5 and showed > 90% positivity for Ki-67. Tumour remission was achieved with six cycles of chemotherapy with the CHOP regime.
Subject(s)
Burkitt Lymphoma/pathology , Mandibular Neoplasms/pathology , Antigens, CD20/biosynthesis , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Biomarkers, Tumor/analysis , Brazil , Burkitt Lymphoma/drug therapy , Burkitt Lymphoma/metabolism , CD3 Complex/biosynthesis , Child, Preschool , Cyclophosphamide/therapeutic use , Doxorubicin/therapeutic use , Humans , Immunohistochemistry , Male , Mandibular Neoplasms/drug therapy , Mandibular Neoplasms/metabolism , Neprilysin/biosynthesis , Prednisone/therapeutic use , Vincristine/therapeutic useABSTRACT
B lymphocyte infiltration in renal acute allograft rejection has been associated with steroid resistance and poor outcomes. We aimed to measure CD20 mRNA in urine of renal transplant patients with graft dysfunction and correlate with the histological diagnosis and immunohistochemical (IH) staining for CD20. A total of 48 urine samples were analyzed (21 with acute rejection, 10 with chronic allograft nephropathy, 11 with unspecific tubular lesions, 3 with acute pyelonephritis and 3 with polyomavirus nephropathy). Higher urinary CD20 levels associated with a positive IH staining for CD20 (>50 positive cells/HPF) in renal tissue (p=0.04), with a sensitivity of 83.3% and a specificity of 51.6%. Within the acute rejection group, a positive staining for CD20 was not associated with graft loss, steroid resistance or lack of return to basal creatinine after treatment, but was associated with higher serum creatinine at 3 and 6 months, 1 and 2 years after the acute episode (p<0.05). In conclusion, we showed that urinary levels of CD20 detected by RT-PCR had a high sensitivity for CD20+ staining in the corresponding renal tissue, but with a low specificity. Patients with clusters of CD20+ cells >50/HPF had higher serum creatinine after 2 years of follow up.