What is the most likely diagnosis for a non-immunized 1-year-old boy, who immigrated from Uganda at age 4, presenting with a 6 x 3 cm solid mass at the right jaw, and histopathology showing infiltration of medium-sized cells with round nuclei, basophilic cytoplasm, vacuoles, and scattered tangible body macrophages with high proliferation rate?

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Differential Diagnosis

  • Single most likely diagnosis
    • Burkitt lymphoma: This is the most likely diagnosis given the patient's age, geographic origin, and the histopathological description of the tumor. The presence of medium-sized cells with round nuclei, basophilic cytoplasm, and vacuoles, along with scattered tangible body macrophages and a high proliferation rate, is characteristic of Burkitt lymphoma. The fact that the patient is from Uganda, a region with high endemicity for Burkitt lymphoma, and is non-immunized, further supports this diagnosis.
  • Other Likely diagnoses
    • Other non-Hodgkin lymphomas (e.g., diffuse large B-cell lymphoma): Although less likely than Burkitt lymphoma, other types of non-Hodgkin lymphoma could present with similar symptoms and histopathological features.
    • Ewing's sarcoma: This malignant bone tumor can present with a rapidly growing mass and may have similar histological features, although the presence of vacuoles and tangible body macrophages is more suggestive of Burkitt lymphoma.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
    • Rhabdomyosarcoma: Although less likely, this malignant soft tissue tumor can present with a rapidly growing mass and may have similar symptoms. Missing this diagnosis could lead to delayed treatment and poor outcomes.
    • Langerhans cell histiocytosis: This rare disorder can present with a variety of symptoms, including masses and bone lesions. Although less likely, it is essential to consider this diagnosis to avoid missing a potentially treatable condition.
  • Rare diagnoses
    • Other rare lymphomas (e.g., anaplastic large cell lymphoma): These lymphomas are less common and may have similar histopathological features, but are less likely given the patient's age and geographic origin.
    • Soft tissue sarcomas (e.g., osteosarcoma, fibrosarcoma): These rare tumors can present with a rapidly growing mass, but are less likely given the histopathological description and the patient's age.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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