Beyond Burkitt: an emerging maxillofacial tumor pattern in equatorial Africa and a shared ecological context

Abstract

Burkitt lymphoma represents a classical model of clinical-epidemiological discovery, in which recognition of a reproducible anatomical and geographical pattern preceded identification of its etiological determinants. Across equatorial Africa, clinicians are increasingly reporting recurrent maxillofacial lesions, including odontogenic tumors such as ameloblastoma and fibro-osseous entities such as fibrous dysplasia and ossifying fibroma. Although biologically heterogeneous, these lesions share key clinical features, including preferential maxillofacial localization, bone-expanding growth, and often indolent presentation. Observations from Central, West, and East Africa suggest clustering within specific populations and geographic regions, frequently overlapping with areas historically associated with endemic Burkitt lymphoma. Current evidence remains limited by the absence of systematic case definitions, population-level denominators, and structured datasets. However, the convergence of clinical and geographic features suggests the emergence of a consistent but under-recognized pattern. While distinct from Burkitt lymphoma, these lesions may arise within a shared ecological context characterized by high infectious burden and sustained human-environment interaction. As with Burkitt lymphoma, early recognition of such patterns may precede mechanistic understanding and should prompt integrated clinical, environmental, and molecular investigation.