1
|
Höglund Wetter M, Mattsson U. Oral manifestations of extranodal lymphomas - a review of the literature with emphasis on clinical implications for the practicing dentist. Acta Odontol Scand 2022; 80:401-410. [PMID: 35108151 DOI: 10.1080/00016357.2021.2020896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Lymphoma is a heterogenous group of malignant tumours with proliferation of lymphoid cells or their precursors. Lymphomas in the head and neck region are usually found in Waldeyer's ring. Intraoral lymphomas are rare and the clinical presentation and roentgenological appearance may resemble other and benign conditions, entailing a risk for diagnostic delay. The objective of the present literature review was to identify subjective symptoms, clinical presentations and roentgenological appearances which should raise suspicion of lymphoma. MATERIALS AND METHODS The literature review identified 41 case series with head and neck lymphomas (n = 3880) and 384 case reports (n = 567 cases) of intraoral lymphomas. Information of demographics, clinical presentation, subjective symptoms and roentgenological appearance was registered. RESULTS The most common clinical presentation was a broad-based swelling or bulging mass with or without simultaneous ulceration, frequently with a relatively rapid growth pattern. Subjective symptoms varied considerably. Intraosseous lymphomas were frequently associated with paresthaesia or numbness. The most common roentgenological finding was a radiolucency with diffuse demarcation. CONCLUSIONS The clinical presentation, symptomatology and roentgenological appearance of intraoral lymphomas varied. Diagnostic delay was usually associated with a lymphoma initially misdiagnosed as a lesion of dental aetiology or a reactive lesion. Inadequate healing after tooth extraction or symptoms of numbness or pain without obvious dental origin should merit further clinical and roentgenological examination. Biopsy is indicated when there is the slightest doubt of the true nature of mucosal lesion.
Collapse
Affiliation(s)
| | - Ulf Mattsson
- Clinic of Medical Dentistry, Central Hospital, Karlstad, Sweden
- Department of Oral pathology, Faculty of Odontology, Malmö University, Sweden
| |
Collapse
|
2
|
Hafian H, Schvartz H, Patey M, Quinquenel A. Primary oral mucosa-associated lymphoid tissue (MALT) lymphoma in patient with monoclonale gammopathy: a rare case report. BMC Oral Health 2021; 21:597. [PMID: 34814897 PMCID: PMC8609828 DOI: 10.1186/s12903-021-01960-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Monoclonal gammopathy is a biological reality encountered in approximately 1% of the general population. In the absence of clinical and biological signs, it is considered of undetermined significance; however, it can be a biological signature of a monoclonal lymphocytic or plasma-cell proliferation. Their localisation to the oral mucosa remains rare and difficult to diagnose, particularly in indolent forms that escape imaging techniques. Case presentation Here, we report the case of a 73-year-old woman with a history of IgM kappa gammopathy followed for 13 years. The patient did not have a chronic infection or an autoimmune disease, and all the biological investigations and radiological explorations were unremarkable during this period. The discovery of a submucosal nodule in the cheek led to the diagnosis of MALT lymphoma and regression of half of the IgM kappa level after resection. The review of the literature shows the dominance of clinical signs (i.e., a mass or swelling) in the diagnosis of primary MALT lymphomas of the oral cavity after surgical resection. Conclusions Our case illustrates the role of examination of the oral cavity in the context of a monoclonal gammopathy. The absence of clinical and radiological evidence in favor of lymphoplasmacytic proliferation, does not exclude a primary indolent MALT lymphoma of the oral mucosa.
Collapse
Affiliation(s)
- Hilal Hafian
- Département Médecine et Chirurgie Orales, Faculté d'Odontologie, Université de Reims Champagne Ardenne, 2, Rue du Général Koenig, 51100, Reims, France. .,Service de Chirurgie Orale, Centre Hospitalier Universitaire de Reims, Hôpital Maison Blanche, 45, Rue Cognac Jay, 51100, Reims, France. .,Laboratoire de Recherche en Nanosciences (LRN), EA 4682, Université de Reims Champagne Ardenne, Reims, France. .,Département de Médecine et Chirurgie Orales, Pôle de Médecine Bucco-Dentaire, Centre Hospitalier Universitaire de Reims, 45, Rue Cognacq-Jay, 51100, Reims, France.
| | - Hubert Schvartz
- Service de Pathologie, Hôpital Robert Debré, CHU de Reims, Reims, France.,Expert Centre of Anatomopathological Network LYMPHOPATH, CHU de Reims - Hôpital Robert Debré, Reims, France
| | - Martine Patey
- Service de Pathologie, Hôpital Robert Debré, CHU de Reims, Reims, France.,Expert Centre of Anatomopathological Network LYMPHOPATH, CHU de Reims - Hôpital Robert Debré, Reims, France
| | - Anne Quinquenel
- Service d'Hématologie Clinique, Hôpital Robert Debré, CHU de Reims, Reims, France.,Réunion de Concertation Pluridisciplinaire Hématologie, Hôpital Robert Debré, CHU de Reims, Reims, France
| |
Collapse
|