HOW “SARCOMA OF THE JAW OF AFRICAN CHILDREN” GOT ITS NAME?

Burkitt lymphoma (BL),  known by the name of the surgeon Dennis Burkitt, who described it in 1958 in children in Uganda was initially described  by him as “sarcoma of the jaw of African children”.

Some questions which came to my mind and might be to others also reading about Burkitt..

Was Burkitt the first person to report this tumour? 
Or was it already documented? 

It was already documented years before Burkitt reported it. The first documentation of the jaw tumours in children in Uganda was given by Albert Cook, a famous Ugandan medical pioneer who established the first hospital in Kampala, Mengo Hospital in 1897.  In the next five to six decades, there were reports by Edington and Thijs about maxillary lymphosarcomas in young children, reticulum cell sarcomas  and atypical round cell sarcomas of the jaw from Gold Coast and the Belgian Congo.Though there were many individual reports on jaw tumours in children, but the first detailed description was published by De Smet in 1956 who described cases of maxillary, orbital, paraspinal, and intra-abdominal lymphosarcomas. 
However, Burkitt’s findings  recognised that the jaw tumours were just one presentation of a single disease with a variety of clinical manifestations.

What was so special about Burkitt describing it and what signficant contribution he made that the lymphoma got his name? 

Read further to know and its more interesting and inspiring...

Journey of Dennis Burkitt in discovering Burkitt Lymphoma.

After 11 years of working as a surgeon in Uganda, he saw a 5 year old boy who had facial deformity caused by bilateral symmetrical swellings of upper and lower jaws. Soon, he saw a girl with similar swellings. He noticed swellings were appearing in other parts of the body with disease progression.  He meticulously searched the records and revived 41 cases of jaw tumours in children. Histology was available in 29 cases and it was similar in all. He did detailed study of autopsy records and presented his findings at a meeting of the East African Association of Surgeons held in Kampala in January 1958. He found that the tumours peaked between 6 and 8 years, majority in upper jaw, grew rapidly and caused severe pain. Significant patients had swellings in other organs of the body (particularly the adrenals, kidneys and liver). Most patients died within 2 or 3 months of the onset of symptoms. But he was not certain of the exact nature of the disease.

Jack Davies described the histology of these tumours as “masses of small round cells with hyperchromatic nuclei similar to lymphocytes and observed that in some cases the tumour resembled a lymphosarcoma”. In 1960, Davies and another colleague, Greg O’Conor, identified the lymphoid origin of the tumour. Earlier they thought it is specific only to African children. But later in a span of few years, childhood lymphoma cases similar to  BL was reported in United States, England, Italy. Burkitt developed questionnaires and collected data from various parts of Africa. Burkitt collaborated with O’Conor and published combined data on clinical and epidemiological profile in 1961. But the etiology of BL was still at question.

In Africa, it was known as Burkitt lymphoma for the tremendous contributions of Burkitt.  At a meeting of the International Union Against Cancer (IUAC), held at United Nations Educational,Scientific and Cultural Organisation (UNESCO) House in Paris in 1963, experts from around the world agreed that Burkitt had described a new disease and that it should be known as Burkitt tumour, which was subsequently modified to Burkitt lymphoma. But even many years after this, Burkitt continued to refer to it as the “African lymphoma” and as mentioned by his friend Cliff Nelson, ‘he tried hard to avoid having the tumour named after him’.

References:

1.     Davis Coakley. Denis Burkitt and his contribution to haematology/oncology. British Journal of Haematology. 2006:135; 17–25.

2.    Carbone A, Rinaldo A, Canzonieri V, Gaidano G, Gloghini A, Ferlito A. Clinicopathological Consultation. Burkitt's lymphoma: Historical background and recent insights into classification and pathogenesis. Ann Otol Rhinol Laryngol.2000: 109;693-702.

See you in the next blog with more interesting topic.

“The journey of discovering the etiology of Burkitt lymphoma.”

                                                                 Written by Dr.Priyavadhana..