Late recurrence of Burkitt’s lymphoma in the jaw: numb chin syndrome as the only symptom

Bernar Monteiro Benites; Wanessa Miranda-Silva; André Caroli Rocha; Ula Lindoso Passos; Felipe Paiva Fonseca; Celso Arrais Rodrigues da Silva; Eduardo Rodrigues Fregnani

doi:10.4322/acr.2020.218

Clinical Case Report

Late recurrence of Burkitt’s lymphoma in the jaw: numb chin syndrome as the only symptom

Bernar Monteiro Benites; Wanessa Miranda-Silva; André Caroli Rocha; Ula Lindoso Passos; Felipe Paiva Fonseca; Celso Arrais Rodrigues da Silva; Eduardo Rodrigues Fregnani

http://dx.doi.org/10.4322/acr.2020.218 Autops Case Rep, vol.11, e2020218, 2021

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Abstract

ABSTRACT: The Numb Chin Syndrome (NCS) is defined as facial and oral numbness restricted to the mental nerve’s distribution involving the lower lip, skin of the chin, or gingiva of the lower anterior teeth. Hypoesthesia can occur unilaterally or bilaterally. Although this syndrome is rare, its importance is related to the fact that it represents the clinical manifestations of malignant diseases. Breast cancer and non-Hodgkin lymphoma are the most common cause of NCS. The patient, a 58-year-old woman, treated for a Burkitt Lymphoma (BL) nine years ago, described a two-week history of change in sensitivity and pain in the chin region, without relief with the use of analgesics. She had no headache, speech disturbance, dysphagia, visual disturbance, or other neurological symptoms. No surgical intervention has been performed recently. The intraoral examination revealed a healthy oral mucosa and a small area adjacent to the right mental nerve region that was uncomfortable to palpation. No changes were found in the bone trabeculae at cone-beam computed tomography. The contrasted magnetic resonance features made it possible to identify a change in the mandibular body extending to the entire right side, coinciding with the patient’s complaint, indicating a probable mandibular medullary invasion. The patient was submitted to a biopsy to rule out a possible recurrence of BL. The microscopic findings were consistent with the diagnosis of BL. The present report described a very unusual presentation of late recurrent BL nine years after the first treatment, which manifested as an NCS.

Keywords

Burkitt Lymphoma, Recurrence, Hypesthesia, B-lymphocytes

References

1 Sasaki M, Yamazaki H, Aoki T, Ota Y, Sekiya R, Kaneko A. Bilateral numb chin syndrome leading to a diagnosis of Burkitt’s cell acute lymphocytic leukemia : a case report and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;111(3):e11-6. http://dx.doi.org/10.1016/j.tripleo.2010.09.066. PMid:21215664.

2 Algahtani H, Shirah B, Bassuni W, Adas R. case report bilateral numb chin syndrome as the initial presentation of Burkitt’s Lymphoma/Leukemia: a report of two cases and review of the literature. Case Rep Hematol. 2016;2016:1-7. http://dx.doi.org/10.1155/2016/3791045. PMid:27882251.

3 Fortunato L, Amato M, Simeone M, Bennardo F, Barone S, Giudice A. Numb Chin Syndrome: a reflection of malignancy or a harbinger of MRONJ? A multicenter experience. J Stomatol Oral Maxillofac Surg. 2018;119(5):389-94. http://dx.doi.org/10.1016/j.jormas.2018.04.006. PMid:29680775.

4 Sánchez-Romero C, Pontes HAR, Pontes FSC, et al. Acute lymphoblastic leukemia/lymphoma of the oral and maxillofacial region. Oral Surg Oral Med Oral Pathol Oral Radiol. 2018;126(2):152-64. http://dx.doi.org/10.1016/j.oooo.2018.01.010. PMid:29678441.

5 Lu SY, Huang S, Chen Y. Numb chin with mandibular pain or masticatory weakness as indicator for systemic malignancy - A case series study. J Formos Med Assoc. 2017;116(11):897-906. http://dx.doi.org/10.1016/j.jfma.2017.07.002. PMid:28728749.

6 Kemp S, Gallagher G, Kabani S. Oral non-Hodgkin’ s lymphoma : review of the literature and World Health Organization classification with reference to 40 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105(2):194-201. http://dx.doi.org/10.1016/j.tripleo.2007.02.019.

7 Silva TDB, Ferreira CBT, Leite GB, Pontes JRM, Antunes HS. Oral manifestations of lymphoma: a systematic review. Ecancermedicalscience. 2016;10(665):1-15. http://dx.doi.org/10.3332/ecancer.2016.665. PMid:27594910.

8 Short NJ, Kantarjian HM, Ko H, et al. Outcomes of adults with relapsed or refractory Burkitt and high-grade B-cell leukemia/lymphoma Running. Am J Hematol. 2017;92(6):E114-7. http://dx.doi.org/10.1002/ajh.24720. PMid:28295472.

9 Calverley JR, Mohnac AM. Syndrome of the Numb Chin. Arch Intern Med. 1963;112(6):819-21. http://dx.doi.org/10.1001/archinte.1963.03860060057003. PMid:14056846.

10 Martos-Díaz P, Bances-del-Castillo R, Vidal-Laso R, Mancha-de-la-Plata M, Cho-Lee GY, Naval-Gías L. Bilateral mental nerve neuropathy as the sole presenting symptom of Burkitt’s Lymphoma. Med Oral Patol Oral Cir Bucal. 2009;14(8):408-10. PMid:19415057.

Submitted date:
02/14/2020

Accepted date:
07/04/2020

Publication date:
12/08/2020

Late recurrence of Burkitt’s lymphoma in the jaw: numb chin syndrome as the only symptom

Bernar Monteiro Benites; Wanessa Miranda-Silva; André Caroli Rocha; Ula Lindoso Passos; Felipe Paiva Fonseca; Celso Arrais Rodrigues da Silva; Eduardo Rodrigues Fregnani

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