The Great Mimicker: Primary Extranodal Burkitt Lymphoma Masquerading as Base of Tongue Carcinoma

Introduction: Primary extranodal Non-Hodgkin’s Lymphomas (NHLs) of the oral cavity are extremely rare (<1% of cases). In adults, Burkitt lymphoma accounts for under 2% of malignant lymphomas in India. Due to their scarcity, base of tongue lesions frequently present as diagnostic dilemmas, often mimicking common epithelial malignancies like squamous cell carcinoma.  Aim: To highlight a rare presentation of primary extranodal Burkitt lymphoma of the base of the tongue, initially masquerading as squamous cell carcinoma, and emphasize the necessity of timely histopathological and immunohistochemical evaluation.  Methodology: A 35-year-old male presenting with foreign body sensation underwent clinical examination, OPD toluidine blue staining, contrast-enhanced MRI (CEMRI) of the oral cavity/neck, and a direct laryngoscopic biopsy. The tissue sample was evaluated via histopathology (H&E) and a targeted panel of immunohistochemical (IHC) markers.  Result: Clinical examination revealed a non-tender 1 cm X 2 cm ulcerative growth at the right base of the tongue. CEMRI suggested a neoplastic lesion consistent with tongue base carcinoma. However, histopathology showed diffusely infiltrating atypical lymphoid cells with tingible-body macrophages. IHC confirmed Burkitt lymphoma.