Rapid jaw swelling with loose teeth in a child
8-year-old male
§Chief complaint
Fast-growing swelling of the upper jaw with loose teeth over 3 weeks
§Medical & dental history
- 01Previously healthy; weight loss and night sweats for 2 weeks
- 02Loose primary and permanent molars on the right
§Clinical examination
- 01Firm swelling of the right maxilla displacing the teeth
- 02Several mobile teeth without caries
- 03Enlarged neck lymph nodes; enlarged abdomen
§ figuresFigures (4)
Fig. 1Burkitt lymphoma, touch prep, Wright stain
“Burkitt lymphoma, touch prep, Wright stain” · Ed Uthman, MD. · CC BY 2.0 · Wikimedia Commons
Fig. 2ID#: 6050 Description: This Nigerian child presented with a large facial tumor due to malignant Burkitt’s lymphoma, a non-Hodgkin’s lymphoma (NHL). Very similar to leukemia, Burkitt’s lymphoma is a very aggressive, malig
“Malignant Burkitt’s lymphoma, a non-Hodgkin’s lymphoma (NHL) 064 lores” · Wikimedia Commons contributor · Public domain · Wikimedia Commons
Fig. 3Facial Burkitt's lymphoma in 7-year-old Nigerian boy, showing disruption of teeth and partial obstruction of airway
“Burkitt's lymphoma” · Mike Blyth · CC BY-SA 2.5 · Wikimedia Commons
Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Burkitt Lymphoma figures pending faculty review.
§Differential diagnosis
§Final diagnosis
Burkitt lymphoma of the maxilla
Biopsy showing sheets of medium-sized B cells with a starry-sky pattern, almost all cells dividing (Ki-67 near 100%) and a MYC rearrangement confirms Burkitt lymphoma.
§Investigations
- 01Urgent biopsy with immunohistochemistry and genetic tests
- 02Bone marrow and spinal fluid samples
- 03PET-CT for staging; kidney function and uric acid
§Radiology
- 01CT — destructive mass of the right maxilla with loss of bone around tooth germs ('floating teeth')
- 02PET-CT — abdominal nodes involved
§Treatment plan
- 01Urgent referral to paediatric oncology
- 02Intensive chemotherapy with measures to prevent tumour lysis syndrome
- 03No major jaw surgery — biopsy only
§Histopathology report
Sheets of uniform medium-sized lymphoid cells with scattered pale macrophages (starry-sky pattern); CD20+, CD10+, BCL2-, Ki-67 ~100%; MYC rearrangement detected. Burkitt lymphoma.
§Follow-up & outcome
- 01Chemotherapy completed over 4 months
- 02PET-CT — complete response
- 03Long-term dental follow-up for affected teeth
Outcome: Complete remission at 2 years.
§Discussion
- 01Burkitt lymphoma is one of the fastest-growing human tumours; the jaw form is classic in the endemic (African) type linked to Epstein-Barr virus.
- 02Cure rates in children exceed 85% with modern chemotherapy.
§Clinical pearls / learning points
- 01Rapid jaw swelling with loose, non-carious teeth in a child needs urgent biopsy.
§Viva questions
Which gene is involved?
MYC on chromosome 8, usually t(8;14).
§MCQs
Q1The 'starry-sky' pattern is typical of:
§ evidenceReferences & Evidence
Current Classification
WHO Classification of Head and Neck Tumours
5th Edition — Volume 9
WHO Classification of Tumours Editorial Board · 2022
The authoritative international classification of head and neck, odontogenic and salivary gland tumours. Current terminology on this site follows this edition.
Evidence summary
Highest level of evidence linked to this page: WHO / Official Classification.
- L1 · Classification — 2
- L6 · Textbook — 3
1 linked source was published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.
Content last reviewed
September 2026
Evidence last reviewed
September 2026
Next scheduled review
September 2027
Review status
EVIDENCE REVIEWED
Search latest PubMed evidence
Last literature search: 7 September 2026
Current Classification
WHO Classification of Tumours Editorial Board. IARC / World Health Organization · 2022
The authoritative international classification of head and neck, odontogenic and salivary gland tumours. Current terminology on this site follows this edition.
IARC / WHO. IARC · 2022
Continuously updated online edition of the WHO head and neck tumour classification.
Histopathology References
Barnes L. CRC Press · 2008
Detailed histopathological reference for head and neck diagnostic criteria.
Textbook References
Neville BW, Damm DD, Allen CM et al.. Elsevier · 2024
Standard reference textbook of oral and maxillofacial pathology used throughout this atlas.
Rajendran R, Sivapathasundharam B. Elsevier · 2020
Undergraduate and postgraduate oral pathology textbook widely used in BDS and FCPS curricula.
Additional sources cited on this page
- WHO Classification of Haematolymphoid Tumours, 5th edition, 2022.
§Similar cases
81 cases in the library