burkitt 's lymphoma ( bl ) is a rare , extranodal malignancy of undifferentiated b lymphocytes commonly seen in children . there are three clinical variants of bl : endemic bl , sporadic bl and hiv associated bl . endemic bl is seen in children in africa and papua new guinea as jaw or orbital masses ; sporadic bl has no specific age or geographic predilection and occurs with abdominal or nodal involvement . immunodeficiency assocociated bl is seen in individuals with hiv.- intraoral presentation of hiv associated burkitt 's lymphoma has been rarely reported . we present to you a case of burkitts lymphoma of the posterior maxilla which was the first manifestation of hiv in the patient . a 42-years - old male presented with a growth in the right maxillary molar region of 2 months duration . there was initial mobility of the tooth in that region for 3 - 4 months followed by exfoliation of the tooth . subsequently , he noticed a growth emerging from the area of the exfoliated tooth which enlarged slowly and gradually . on extraoral examination , there was a diffuse swelling noticed over the right malar region which was non tender on palpation . on intraoral examination , there was a solitary , well defined , pedunculated growth in the right maxillary molar region which was predominantly blackish in appearance [ figure 1 ] . intraoral radiographs showed missing maxillary right second molar with bone loss extending beyond the tooth socket till the floor of the right maxillary sinus . panoramic radiography showed soft tissue shadow distal to the right maxillary first molar with break in the continuity of the antral floor in the same region [ figure 2 , area encircled in black ] . histopathological analysis of the lesion showed sheets of round cells with vesicular nuclei and indistinct cytoplasm interspersed with lymphocytes with condensed nuclei . unfortunately , due to certain logistical and financial reasons the patient did not report back to us and was subsequently lost to follow up . clinical image showing growth in right maxillary posterior region panoramic radiograph showing break in continuity of antral floor , ill defined radiolucency and soft tissue shadow ( encircled in black ) photomicrograph ( h and e , x 10 ) showing sheets of round cells with vesicular nuclei and indistinct cytoplasm interspersed with lymphocytes and macrophages human immunodeficiency virus ( hiv ) infection has been associated with a 60 fold increased risk of non hodgkin lymphoma ( nhl ) . nhl forms around one third of aids - related malignancies with burkitt 's lymphoma accounting for 2.4 - 20% of hiv - associated nhl . burkitt 's lymphoma ( bl ) was originally described by dr denis burkitt in 1958 as a sarcoma of the jaw in children in endemic areas of equatorial east africa . later on , sporadic cases were reported from europe and america which were histologically and immunophenotypically identical and these were known as nonendemic or north american burkitt 's lymphoma . the third type known as immunodeficiency associated bl , usually seen in association with human immunodeficiency virus ( hiv ) infection , is clinically similar to the sporadic cases but with higher incidence of lymph node and bone marrow involvement . in an indian series of solid malignant tumours , burkitt 's lymphoma had an incidence of 0.76% . burkitt 's lymphoma has the highest proliferation rate of any human neoplasm , with a potential doubling time of 24 hours and a growth fraction of nearly 100% . differences in adult and pediatric presentation : the pathogenesis of bl is due to the c - myc immunoglobulin ( ig ) translocation and is thought to occur as a result of an error in activation induced cytidine deaminase ( aid)-mediated ig class switch recombination in germinal centers . the most common translocation in bl is the t ( 8;14)in which there is fusion of cmyc to the immunoglobin ( ig)h locus . jaw involvement is seen in approximately 60% of cases in endemic bl , while it occurs in only 15 - 18% of nonendemic bl . the earliest clinical sign of intraoral bl is loosening and exfoliation of the teeth as the tumour enlarges . the tumor can cause toothache , tooth mobility , tooth displacement , intraoral and extraoral swelling , and perioral paresthesia . the differential diagnosis usually includes the following conditions : p0 eriapical lesions , ameloblastoma , other non - hodgkin 's lymphomas , undifferentiated carci - nomas and sarcomas , and leukemia . radiographic findings in burkitt 's lymphoma include radiolucent images of bone destruction with poorly defined and irregular margins . in children , the tumor can cause generalized destruction of the tooth crypts with loss of lamina dura and loss of trabecular pattern in the mandible and maxilla . in our case , there was ill defined radiolucency of the alveolar bone posterior to the first molar tooth . histologically , classic bl presents with monotonous , intermediate sized neoplastic cells with round nuclei and multiple peripheral nuclei with scant cytoplasm and clear vacuoles . mitotic figures are abundant with numerous interspersed tingible body macrophages phagocytosing abundant apoptotic debris , thus creating the starry - sky pattern . burkitt 's lymphoma is treated preferentially with intensive chemotherapy ; 5-year survival rates range between 75 and 95% , depending on the stage of the lesion at the time of diagnosis . new chemotherapeutic agents such as daunorubicine , arabinoside - c , tioguanide and hydroxyurea have been added to the classical treatment scheme . prognosis improves with younger age of diagnosis , minimal tumour burden and prompt initiation of chemotherapy . it has been highlighted that bl in an hiv - infected person may be one of the first clinical findings . in our case also , the oral manifestation of bl was the first manifestation of hiv . thus , hiv positive patients present with a variety of clinical manifestations . the diagnosis of burkitt 's lymphoma in an otherwise healthy appearing individual should raise suspicion of underlying immunosuppression and appropriate investigations for hiv must be undertaken .
burkitt 's lymphoma is an aggressive form of non - hodgkin 's lymphoma composed of malignant cells of b lymphocyte origin . 
 burkitt 's lymphoma is a rarity in the indian subcontinent . 
 though intraoral burkitt 's lymphoma in hiv positive individuals is very uncommon , its importance lies in the fact that it is often the first sign of the underlying immunosuppression . 
 we present a case of burkitt 's lymphoma in right maxillary region which was the first manifestation of hiv in the patient .