Studies of Cancer in Humans
2. Studies of Cancer in Humans 2.1 Burkitt9slymphoma 2.1.1 Clinical features and pathology 2.1.1 .1 Clinicalfeatures The jaw is the most frequently involved site and the commonest presenting feature in patients with Burkitt's lymphoma in equatorial Africa (Burkitt, 1958, 1970a) and Papua- New Guinea (ten Seldam et al., 1966; Bukitt, 1967; Magrath ef al., 1992). The tumour frequently affects multiple jaw quadrants (Figure 5). Jaw involvement is age-dependent, occurring much more frequently in young children, since it arises in close proximity to the developing molar tooth buds. In series of cases of Burkitt's lymphoma in Uganda, 70% of children under five years of age and 25% of patients over I4 had jaw invoIve- ment (Burkitt, 1970a). Very young children who do not have overt jaw tumours often have orbital involvement (Olurin & Williams, 1972; Figure 6); some of these orbital turnours may arise in the maxilla. In general, jaw involvement appears to be more frequent in regions of higher incidence, even within equatorial Africa; however, patients from, for example, highland regions in Africa, in which the annual incidence rate of Burktt's lymphoma is muck lower, are also of higher median age, and this probably accounts for the lower frequency of jaw turnours (Buxkitt & Wright, 1966; Kitinya & Lauren, 1982). It has been suggested that the frequency of jaw tumours is decreasing in some regions of equatorial Africa, with a corresponding increase in the fraction of abdominal turnours but with no clear change in the age-related incidence (Nawnah, 1984). Abdominal invo1vement is found in a little more than half of equatorial AErican patients at presentation (Burkitt & Wright, 1963; Burkitt, 1970b; Williams, 1975) and as many as 80% of patients in other countries (Magrath, 1991, 1997).
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