Burkitt lymphoma after adenoidectomy – Importance of histologic examination

Introduction:

Typical symptoms of adenoid hyperplasia in childhood are chronic mouth breathing with ronchopathy, recurrent infections of the respiratory tract and tubal ventilation disorder. The treatment is an adenoidectomy and if necessary with drainage of the middle ear. Differential diagnosis of impeded nasal breathing in childhood are very rare causes such as choanal atresia, juvenile angiofibroma, malignant lymphoma or a foreign body.

Case history and methods:A 6-year-old patient was admitted to the hospital with typical symptoms of adenoid hyperplasia in childhood such as chronic mouth breathing with ronchopathy, recurrent infections of the respiratory tract, hearing loss and a delay of the language development. The examination of the nasopharynx was hardly possible due to the incompliance of the patient. The ear microscopy middle ear effusion. Conservative treatment was unsuccessful so we decided to do an adenoidectomy with myringotomy with ventilation tube insertion. The nasopharynx showed intraoperatively filled with a mass of soft tissue. Surprisingly the histological examination showed a Burkitt's lymphoma. After the diagnosis, we referred the patient to our paediatric clinic for further management and treatment of the lymphoma. At the present time the disease of the patient is in complete remission.

Conclusion:

The histological examination of the excised tissue after adenoidectomy is not a routine procedure in every clinic. However, in rare cases a malignant disease such as a lymphoma can also present with the typical symptoms of adenoid hyperplasia. The right diagnosis can be established only with the histological examination, which then leads to an adequate treatment of these patients. This case shows the great importance of the histological examination.

Publication History

Publication Date:
18 April 2018 (online)