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Sarda P, Gurram P, Ramakrishnan K, Narayanan V, Chandran S, Vinayachandran D. Diagnostic dilemma in maxillofacial pathologies: a case series. J Med Case Rep 2024; 18:174. [PMID: 38515220 PMCID: PMC10956309 DOI: 10.1186/s13256-024-04408-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/05/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Head and neck are a site of numerous pathologies with different aetiologies and presentations. Rare pathologies, although infrequent still do exist. Diagnostic dilemma in maxillofacial pathologies can be the most challenging situation. Dealing with uncertainty, although difficult, is a reality in surgical practice. Being thorough, attentive to details and clues, and maintaining an open mind are critical strategies in the approach to such a patient. CASE PRESENTATION In our paper we are reporting a spectrum of 4 unusual variants of head and neck pathologies, whose age and sex were 52 years/ M, 37 years/F, 41 years/ F, 30 years/F respectively. All the patients were of Indian origin. The diagnosis ranged from autoimmune diseases to lymphatic cancer which posed a unique challenge both in the terms of diagnosis and management. CONCLUSION A thorough systematic evaluation along with a multidisciplinary approach is mandatory in the diagnosis of unusual head and neck pathologies.
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Affiliation(s)
- Pavithra Sarda
- Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRMIST, Kattankulathur, Chengalpattu, Tamil Nadu, 600203, India
| | - Prashanthi Gurram
- Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRMIST, Kattankulathur, Chengalpattu, Tamil Nadu, 600203, India.
| | - Karthik Ramakrishnan
- Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRMIST, Kattankulathur, Chengalpattu, Tamil Nadu, 600203, India
| | - Vivek Narayanan
- Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRMIST, Kattankulathur, Chengalpattu, Tamil Nadu, 600203, India
| | - Saravanan Chandran
- Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRMIST, Kattankulathur, Chengalpattu, Tamil Nadu, 600203, India
| | - Divya Vinayachandran
- Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRMIST, Kattankulathur, Chengalpattu, Tamil Nadu, 600203, India
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Ma W, Hong R, Lou P, Yao M, Wu S, Lin C, Wang C, Chang C, Cheng A, Kuo S. Improved outcomes of localized diffuse large B-cell lymphoma at the Waldeyer ring in comparison to the sinonasal area in the rituximab era. Cancer Med 2023; 13:e6851. [PMID: 38148602 PMCID: PMC10807621 DOI: 10.1002/cam4.6851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 11/28/2023] [Accepted: 12/10/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Diffuse large B-cell lymphoma (DLBCL) of the head-and-neck area primarily involves the Waldeyer ring (WR) and sinonasal area (SN). However, the differential clinical outcomes between patients with WR-DLBCL and those with SN-DLBCL in the rituximab era remain unclear. METHODS To avoid confounding factors contributed by advanced DLBCL with WR and SN involvement, we assessed the clinical outcomes of patients with stage I/II WR-DLBCL and SN-DLBCL and compared them with those having corresponding stages of DLBCL in the lymph nodes but without other extranodal involvement (LN-DLBCL) in the same period. We compared the patients' clinical characteristics, treatment modalities, event-free survival (EFS), and overall survival (OS) among the three subgroups. RESULTS We analyzed 67, 15, and 106 patients with WR-DLBCL, SN-DLBCL, and LN-DLBCL, respectively, between January 2000 and December 2019. All patients received front-line rituximab-based regimens, and > 80% received rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone-based regimens. More patients with SN-DLBCL had revised International Prognostic Index (R-IPI) score 3 (27%) when compared with those with WR-DLBCL (7%) and those with LN-DLBCL (10%, p = 0.181). Patients with WR-DLBCL, LN-DLBCL, and SN-DLBCL had 5-year EFS and OS rates of 80.7%, 59.5%, and 41.9% (p = 0.021) and 83.7%, 70.8%, and 55.8% (p = 0.032), respectively. Compared to patients with LN-DLBCL, those with WR-DLBCL also had a significantly favorable 5-year EFS rate (p = 0.021) and 5-year OS rate (p = 0.023). Three of the 15 patients with SN-DLBCL experienced lymphoma recurrence in the brain after front-line treatment. In multivariate analyses, R-IPI scores of 1-2 and 3 served as significantly poor prognostic factors for patients with poor EFS and OS. CONCLUSIONS Compared to patients with LN-DLBCL, patients with WR-DLBCL receiving front-line rituximab-based treatments had favorable clinical outcomes; however, patients with SN-DLBCL had worse clinical outcomes. Further studies on molecular prognostic factors and treatment strategies for SN-DLBCL are warranted.
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Affiliation(s)
- Wei‐Li Ma
- Department of OncologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
- Cancer Research CenterNational Taiwan University College of MedicineTaipei CityTaiwan
- Graduate Institute of OncologyNational Taiwan University College of MedicineTaipei CityTaiwan
| | - Ruey‐long Hong
- Department of OncologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
- Department of Medical OncologyNational Taiwan University Cancer Center, National Taiwan University College of MedicineTaipei CityTaiwan
| | - Pei‐Jen Lou
- Department of OtolaryngologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
| | - Ming Yao
- Department of Internal MedicineNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
| | - Shang‐Ju Wu
- Department of Internal MedicineNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
| | - Chung‐Wu Lin
- Department of PathologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
- Department of Pathology and Laboratory MedicineKoo Foundation Sun Yat‐Sen Cancer CenterTaipei CityTaiwan
| | - Chun‐Wei Wang
- Department of OncologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
- Cancer Research CenterNational Taiwan University College of MedicineTaipei CityTaiwan
| | - Chin‐Hao Chang
- Department of Medical ResearchNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
| | - Ann‐Lii Cheng
- Department of OncologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
- Graduate Institute of OncologyNational Taiwan University College of MedicineTaipei CityTaiwan
- Department of Medical OncologyNational Taiwan University Cancer Center, National Taiwan University College of MedicineTaipei CityTaiwan
- Department of Internal MedicineNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
| | - Sung‐Hsin Kuo
- Department of OncologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
- Cancer Research CenterNational Taiwan University College of MedicineTaipei CityTaiwan
- Graduate Institute of OncologyNational Taiwan University College of MedicineTaipei CityTaiwan
- Department of Radiation OncologyNational Taiwan University Cancer Center, National Taiwan University College of MedicineTaipei CityTaiwan
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Kuceki G, Nguyen C, Ng D, Wada D, Mathis J. Oral diffuse large B-cell lymphoma presenting as a bland nodule. JAAD Case Rep 2023; 36:34-37. [PMID: 37215296 PMCID: PMC10195845 DOI: 10.1016/j.jdcr.2023.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Affiliation(s)
- Guilherme Kuceki
- Department of Dermatology, University of Utah, Salt Lake City, Utah
| | - Cassidy Nguyen
- Department of Dermatology, University of Utah, Salt Lake City, Utah
| | - David Ng
- Department of Pathology, University of Utah, Salt Lake City, Utah
| | - David Wada
- Department of Dermatology, University of Utah, Salt Lake City, Utah
| | - Jason Mathis
- Department of Dermatology, University of Utah, Salt Lake City, Utah
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Faisal M, Mariyam R, Krishna J, Basheer B. A rare case of high-grade non-Hodgkin's lymphoma with oral and multiple extranodal manifestations. Natl J Maxillofac Surg 2023; 14:147-151. [PMID: 37273429 PMCID: PMC10235732 DOI: 10.4103/njms.njms_497_21] [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: 11/19/2021] [Revised: 01/25/2022] [Accepted: 04/25/2022] [Indexed: 06/06/2023] Open
Abstract
Lymphomas are a group of malignant diseases affecting the lymphoreticular system. Lymphoma is the second most common neoplasm of the head and neck after squamous cell carcinoma, but the incidence of lymphomas in the oral cavity and orbit is rare. Non-Hodgkin's lymphoma (NHL) is less predictable than Hodgkin's but has a greater predilection to extranodal tissues. Non-Hodgkin's incidence in extranodal sites accounts for about 20% to 30%, but in the oral cavity, its around 0.1% to 5%. The rarity of incidence in the oral cavity and atypical radiographic features diagnosing a lymphoma is quite a challenge for clinicians. Here we describe a case of 31-year-old male patient with high-grade non-Hodgkin's lymphoma involving oral cavity with metastasis to orbit, skeletal structures, testes, liver, pancreas and nasopharynx, which is quite rare.
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Affiliation(s)
- Mohammed Faisal
- Maxillofacial Surgeon, Mother Care Hospital, Mannarkad, Kerala, India
| | | | | | - Binshad Basheer
- Department of Oral Maxillofacial Surgery, KMCT Dental College, Mukkam, Calicut, Kerala, India
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Sorrentino A, Ferragina F, Barca I, Arrotta A, Cristofaro MG. Extra-Nodal Lymphomas of the Head and Neck and Oral Cavity: A Retrospective Study. Curr Oncol 2022; 29:7189-7197. [PMID: 36290843 PMCID: PMC9601190 DOI: 10.3390/curroncol29100566] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 01/13/2023] Open
Abstract
Disease Overview: Lymphomas, both Hodgkin's and non-Hodgkin's lymphomas, are one of the most common cancers in the head and neck area. The extra-nodal variant of lymphoma is rare, but it is the most common non-Hodgkin's lymphoma (ENHL). Furthermore, it is difficult to diagnose due to its non-specific clinical and radiological features, which can mimic other benign or malignant clinical manifestations. The study: This retrospective study involved 72 patients affected by head and neck ENHL in the period between 2003 and 2017. All patients underwent a diagnostic-therapeutic procedure according to the guidelines, and a 5-year follow-up. Based on the location of the swelling at the time of diagnosis, patients were divided into two groups: oral and non-oral ENHLs. Statistical analysis was performed using Kaplan-Meier analysis with the log-rank test. In addition, Fisher's exact test was applied to the two groups to evaluate and compare variances (the acceptable significance level was set at p < 0.05). Conclusion: ENHL with oral localization is much more aggressive than ENHL with non-oral localization, with a death rate of 40% (versus 4.76 for the non-oral one). In fact, between the two groups, there is a statistically significant difference in mortality, with a p-value of 0.0001 and 0.0002, respectively.
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Affiliation(s)
- Alfonso Sorrentino
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Unit of Maxillofacial Surgery, University Hospital of Naples “Federico II”, 80131 Napoli, Italy
| | - Francesco Ferragina
- Department of Experimental and Clinical Medicine, Unit of Maxillofacial Surgery, “Magna Graecia” University, Viale Europa, 88100 Catanzaro, Italy
- Correspondence: ; Tel.: +39-0961-364-7271; Fax: +39-0961-364-7229
| | - Ida Barca
- Department of Experimental and Clinical Medicine, Unit of Maxillofacial Surgery, “Magna Graecia” University, Viale Europa, 88100 Catanzaro, Italy
| | - Antonella Arrotta
- Department of Medicine and Surgery Sciences, Magna Graecia University, Viale Europa, 88100 Catanzaro, Italy
| | - Maria Giulia Cristofaro
- Department of Experimental and Clinical Medicine, Unit of Maxillofacial Surgery, “Magna Graecia” University, Viale Europa, 88100 Catanzaro, Italy
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Yun YB, Bae WY, Kim S, Park MG. A Case of Primary Diffuse Large B Cell Lymphoma of the Maxillary Sinus Presenting as Epiphora. JOURNAL OF RHINOLOGY 2022. [DOI: 10.18787/jr.2021.00397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Primary sinusoidal non-Hodgkin’s lymphoma (NHL) is a very rare disease. The main symptoms of sinusoidal NHL are rhinorrhea, nasal obstruction, and post-nasal drip. Symptoms such as eye protrusion, diplopia, trismus, and periorbital pain can also occur. Epiphora is a very rare symptom of sinusoidal NHL, which can lead to a misdiagnosis of dacryocystitis or dacryostenosis. The authors report the case of a 46-year-old female patient who visited hospital for symptoms of epiphora, which did not improve even after 3 months of eye treatment, leading to a final diagnosis of maxillary NHL.
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Kaur R, Shetty D, Bagal BP, Gujral S, Sengar M, Laskar S, Nayak L, Shet T. Extranodal MALT Lymphoma in the Oral Cavity: A Series of Three Cases with Review of Literature. Head Neck Pathol 2022; 16:1242-1250. [PMID: 35674932 PMCID: PMC9729474 DOI: 10.1007/s12105-022-01461-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 04/29/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Diagnosis of MALT lymphoma in the oral cavity is challenging. There is a great overlap in the histopathologic, immuno-histochemical and molecular features of MALT lymphoma with reactive lymphoid proliferations. The literature shows a very few case reports of primary MALT lymphoma of oral cavity. METHODS We discuss the histopathologic, immuno-histochemical, cytogenetic features, treatment and behavior of 3 cases of primary MALT lymphoma oral cavity along with review of literature. RESULTS The age ranged from 40 to 57 years (male to female ratio = 2:1). The sites involved were hard palate, bilateral gingivobuccal sulcus and right buccal mucosa. The most common histology was centrocyte-like (2 cases). Lymphoepithelial lesions were absent. On immunohistochemistry, all tumors showed diffuse strong CD20 and bcl2 expression with strong and diffuse MNDA staining in one case. IgH; MALT1 translocation was not seen in any of these cases. One patient received local radiotherapy, one received steroids; while the case 3 received RCHOP (Rituximab, cyclophosphamide, hydroxydaunorubicin hydrochloride, vincristine and prednisone) chemotherapy. Two patients had complete remission while one had recurrence. CONCLUSION MALT lymphoma of oral cavity shows a wide spectrum of morphology with presence of transformed cells, that may lead to misdiagnosis of DLBL. Treatment guidelines are not well established but a tendency to excise MALT lymphomas of oral cavity has been observed. Nevertheless, MALT lymphoma of oral cavity appears to be an indolent disease.
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Affiliation(s)
- Ramandeep Kaur
- Tata Memorial Hospital, Dr E.B. Road, Parel, Mumbai, Maharashtra 400012 India
| | - Dhanlaxmi Shetty
- Tata Memorial Hospital, Dr E.B. Road, Parel, Mumbai, Maharashtra 400012 India
| | - Bhausaheb P. Bagal
- Tata Memorial Hospital, Dr E.B. Road, Parel, Mumbai, Maharashtra 400012 India
| | - Sumeet Gujral
- Tata Memorial Hospital, Dr E.B. Road, Parel, Mumbai, Maharashtra 400012 India
| | - Manju Sengar
- Tata Memorial Hospital, Dr E.B. Road, Parel, Mumbai, Maharashtra 400012 India
| | - Siddhartha Laskar
- Tata Memorial Hospital, Dr E.B. Road, Parel, Mumbai, Maharashtra 400012 India
| | - Lingaraj Nayak
- Tata Memorial Hospital, Dr E.B. Road, Parel, Mumbai, Maharashtra 400012 India
| | - Tanuja Shet
- Tata Memorial Hospital, Dr E.B. Road, Parel, Mumbai, Maharashtra 400012 India ,Department of Pathology, Tata Memorial Hospital, 8th floor, Annexe building, Lower Parel, Mumbai, Maharashtra 400012 India
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8
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Oral Malignant Non-Hodgkin Lymphoma: A Retrospective Single-Center Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052605. [PMID: 35270301 PMCID: PMC8909803 DOI: 10.3390/ijerph19052605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/12/2022] [Accepted: 02/22/2022] [Indexed: 12/13/2022]
Abstract
This study aimed to retrospectively evaluate the incidence of oral non-Hodgkin lymphoma (NHL) in patients referred to the Academic Hospital of the Magna Graecia University of Catanzaro from 2002 to 2020. A retrospective single-center study was performed. Patients with a histologically confirmed diagnosis of oral NHL were included. Demographic data and clinical parameters were digitally recorded, focusing on the NHL-specific localization and symptomatology. The study sample was evaluated by analyzing descriptive statistics with absolute and relative frequencies. A total of 26 patients with intraoral NHL were identified with a progressive increase in NHL occurrence during the observation period. Clinical manifestations included swelling/mass (80.7%), eventually associated with pain and ulcerations. The most common localizations were in soft tissues: buccal mucosa (38.4%), tongue (19.2%), gingiva (11.5%), cheek (11.5%). Oral NHL is rare. Clinical manifestations were unspecific, so a misdiagnosis could occur. The extranodal B-cell form of oral NHL, particularly diffuse large B-cell lymphoma, was the most common frequent oral NHL in this southern Italian population, with a progressively increased occurrence in almost 20 years.
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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.
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Affiliation(s)
| | - Ulf Mattsson
- Clinic of Medical Dentistry, Central Hospital, Karlstad, Sweden
- Department of Oral pathology, Faculty of Odontology, Malmö University, Sweden
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Michi Y, Harada H, Oikawa Y, Okuyama K, Kugimoto T, Kuroshima T, Hirai H, Mochizuki Y, Shimamoto H, Tomioka H, Kachi H, Sakamoto JI, Kayamori K, Yoda T. Clinical manifestations of diffuse large B-cell lymphoma that exhibits initial symptoms in the maxilla and mandible: a single-center retrospective study. BMC Oral Health 2022; 22:20. [PMID: 35081952 PMCID: PMC8793180 DOI: 10.1186/s12903-022-02056-x] [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: 07/01/2021] [Accepted: 01/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diffuse large B-cell lymphoma (DLBCL) is the most common type of lymphatic tumor; however, extranodal DLBCLs that exhibit initial symptoms in the maxilla and mandible are rare. Moreover, DLBCL is clinically classified as a moderate to highly malignant lymphatic tumor that can progress rapidly; therefore, early diagnosis is crucial. However, diagnosis is difficult as the disease causes a diverse range of clinical symptoms with no characteristic imaging findings. We conducted a clinical investigation to clarify the clinical characteristics of DLBCL that exhibits initial manifestation in the maxilla and mandible. METHODS Of the 2748 patients with malignant tumors of the oral and maxillofacial region examined at our hospital during a period of 11 years between January 2006 and December 2016, 27 primary cases diagnosed with DLBCL based on the chief complaint of symptoms in the gingiva and bone of the maxilla and mandible were enrolled in this study. Evaluations were based on sex, age, whether treatment was provided by a previous physician, symptoms, duration of disease until treatment was sought, clinical diagnosis, laboratory findings, and imaging results. RESULTS There were 15 cases that involved the maxilla and 12 that involved the mandible. The median duration of disease until treatment was sought was 60 d (3-450 d). All cases exhibited a tumor or a mass, and hypoesthesia of the chin was confirmed in eight cases wherein the mandible was involved. The clinical stages were stage I in eight cases, stage II in ten cases, and stage IV in nine cases. Serum lactate dehydrogenase (LDH) levels were elevated in 13 of 22 patients. The overall survival rate was 63%. CONCLUSIONS Symptoms associated with nontender swelling and numbness of the lip or chin in the absence of other findings such as dental infections should raise suspicions about DLBCL. Patients should be provided appropriate imaging and accurate biopsy assessments to improve prognosis.
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Affiliation(s)
- Yasuyuki Michi
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan.
| | - Hiroyuki Harada
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Yu Oikawa
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Kohei Okuyama
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Takuma Kugimoto
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Takeshi Kuroshima
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Hideaki Hirai
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Yumi Mochizuki
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Hiroaki Shimamoto
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Hirofumi Tomioka
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Hirokazu Kachi
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Jun-Ichiro Sakamoto
- Department of Oral and Maxillofacial Radiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Kou Kayamori
- Department of Oral Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Tetsuya Yoda
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
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Catania R, Belloni E, Preda L, Bortolotto C, Scagnelli P, Calliada F. Odontogenic-Like Pain in Partial Edentulism: An Unusual Presentation of Diffuse Large B-Cell Lymphoma of the Mandible. Indian J Radiol Imaging 2022; 31:1053-1056. [PMID: 35136528 PMCID: PMC8817793 DOI: 10.1055/s-0041-1741552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Primary bone lymphoma is a rare entity and it usually occurs in long bones. Primary mandibular involvement is very rare, and it usually shows unspecific features, mimicking odontogenic inflammatory lesions. We present the unusual case of a diffuse large B-cell lymphoma (DLBCL) of the right mandibular body in a 91-year-old woman, who presented with acute pain in the mandibular region initially suspicious for odontogenic abscess. No significant findings were seen on orthopantomography (OPG) and her almost complete edentulism made the diagnosis of abscess unlikely. Computed tomography and magnetic resonance images showed an expansive mass around the right mandibular body with erosion of cortical bone and involving the right mandibular canal and nerve. Final diagnosis of DLBCL was pathologically proven. The presence of odontogenic-like pain in nearly complete edentulism should be suspicious for malignancy, and it needs further diagnostic workup despite the absence of signs on OPG.
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Affiliation(s)
- Roberta Catania
- Department of Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elena Belloni
- Department of Radiology, Civil Hospital, Vigevano, Italy
| | - Lorenzo Preda
- Diagnostic Imaging Unit, National Centre of Oncological Hadrontherapy, Pavia, Italy
| | - Chandra Bortolotto
- Department of Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paola Scagnelli
- Department of Radiology, Ospedale Maggiore di Lodi, Lodi, Italy
| | - Fabrizio Calliada
- Department of Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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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.
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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
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Georgaki M, Theofilou VI, Pettas E, Piperi E, Stoufi E, Panayiotidis P, Nikitakis NG. Blastoid Mantle Cell Lymphoma of the Palate: Report of a Rare Aggressive Entity and Review of the Literature. Head Neck Pathol 2021; 16:631-642. [PMID: 34716903 PMCID: PMC9187827 DOI: 10.1007/s12105-021-01391-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/22/2021] [Indexed: 11/25/2022]
Abstract
Mantle cell lymphoma (MCL) is a well-defined, non-Hodgkin lymphoma of B-cell origin displaying diverse morphological phenotypes and variable disease course. The World Health Organization recognizes two aggressive histopathologic variants of this type of lymphoma: pleomorphic and blastoid MCL. To date, only few cases of MCL affecting the oral cavity have been reported. Additionally, the involvement of the oral and maxillofacial area by aggressive MCL subsets is considered extremely rare with only two patients reported in the English language literature to the best of our knowledge. Herein, we describe a 69 year-old male with a prior history of MCL of the right lateral pharyngeal wall developing a recurrent lesion extending to the palatal mucosa as diffuse ulceration and exhibiting histomorphological features of blastoid MCL. We also review the pertinent literature with emphasis on the diagnostic challenges and distinction between the different MCL variants.
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Affiliation(s)
- Maria Georgaki
- Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens, 2 Thivon St., Goudi, 11527, Athens, Greece.
| | - Vasileios Ionas Theofilou
- Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens, 2 Thivon St., Goudi, 11527, Athens, Greece
- Department of Oncology and Diagnostic Sciences, School of Dentistry, University of Maryland, Baltimore, USA
| | - Efstathios Pettas
- Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens, 2 Thivon St., Goudi, 11527, Athens, Greece
| | - Evangelia Piperi
- Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens, 2 Thivon St., Goudi, 11527, Athens, Greece
| | - Eleana Stoufi
- Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens, 2 Thivon St., Goudi, 11527, Athens, Greece
| | - Panayiotis Panayiotidis
- First Propaedeutic Department of Internal Medicine "Laiko" Hospital, Medical School, University of Athens, Athens, Greece
| | - Nikolaos G Nikitakis
- Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens, 2 Thivon St., Goudi, 11527, Athens, Greece
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14
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Jiang R, Zhang HM, Wang LY, Pian LP, Cui XW. Ultrasound features of primary non-Hodgkin’s lymphoma of the palatine tonsil: A case report. World J Clin Cases 2021; 9:8470-8475. [PMID: 34754855 PMCID: PMC8554430 DOI: 10.12998/wjcc.v9.i28.8470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/26/2021] [Accepted: 07/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Lymphomas are the second most common malignancy of the head and neck. In this region, the vast majority of extranodal lymphomas are located in the palatine tonsil, accounting for about 51%. Tonsillar lymphomas are aggressive tumors with intermediate- or high-grade histology. We here report a case of primary non-Hodgkin’s lymphoma of the palatine tonsil and analyze its ultrasound features.
CASE SUMMARY A 40-year-old man presented with right palatine tonsil swelling for 2 mo after a cold, accompanied by dysphagia, snoring, and suffocation. He had no sore throat, fever, or history of upper respiratory tract infection or tuberculosis. The patient was generally in good health and denied other diseases. He was diagnosed with acute tonsillitis initially and treated with antibiotics for 7 d. However, there was no improvement with the treatment. Tonsil biopsy and ultrasound-guided biopsy of the biggest lymph node of the right neck showed the typical pathology of non-Hodgkin lymphoma.
CONCLUSION Primary lymphoma of the tonsils is rare, and its diagnosis is challenging. Ultrasound is a useful modality in diagnosing oropharyngeal diseases, and can clearly show the features of this tumor, but the final diagnosis should be established by histology.
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Affiliation(s)
- Ru Jiang
- The Third Clinical Medical College of Henan University of Chinese Medicine, Henan University of Chinese Medicine, Zhengzhou 450000, Henan Province, China
| | - Hong-Mei Zhang
- The Third Clinical Medical College of Henan University of Chinese Medicine, Henan University of Chinese Medicine, Zhengzhou 450000, Henan Province, China
| | - Lin-Ying Wang
- Department of Ultrasound, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450000, Henan Province, China
| | - Lin-Ping Pian
- Department of Ultrasound, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450000, Henan Province, China
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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15
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Xia S, Yue J, Chen X, Hu Y, Guo F, Zhang J. Clinicopathological and genetic characteristics of diffuse large B-cell lymphoma of the oropharyngeal and maxillofacial region. Oral Dis 2020; 27:448-456. [PMID: 32731312 DOI: 10.1111/odi.13578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/23/2020] [Accepted: 07/14/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The study was aimed to analyze the clinicopathological and molecular pathological features of diffuse large B-cell lymphoma (DLBCL) in the oropharyngeal and maxillofacial region. SUBJECTS AND METHODS A retrospective review was performed with 36 patients who were diagnosed with primary DLBCL of the oropharyngeal and maxillofacial region from 2009 to 2017 in the Department of Pathology at the Hospital of Stomatology, Wuhan University. Immunohistochemistry and fluorescence in situ hybridization were performed. RESULTS Gene rearrangements of BCL2, BCL6, and MYC were observed in 5.6%, 33.3%, and 22.2%, respectively, including two double-hit and one triple-hit DLBCL (8.3%). There was a significant correlation between MYC protein expression and gene translocation (rs = 0.679, p < .001). However, 25% of cases with MYC rearrangement showed low MYC protein expression. In univariate analysis, MYC protein expression, BCL2 rearrangement, MYC rearrangement, and double/triple-hit DLBCL were associated with shorter overall survival, whereas only MYC protein expression was an independent prognostic value in multivariate model. CONCLUSIONS MYC protein expression was an essential prognostic marker of DLBCL in the oropharyngeal and maxillofacial region. Notably, immunohistochemical staining of MYC, BCL2, and BCL6 could not predict their gene rearrangements, although MYC protein expression was correlated with gene translocation.
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Affiliation(s)
- Shu Xia
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei_MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China.,Oral Histopathology Department, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Junqiu Yue
- Department of Pathology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinming Chen
- Oral Histopathology Department, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Yaying Hu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei_MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China.,Oral Histopathology Department, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Fang Guo
- Department of Pathology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiali Zhang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei_MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China.,Oral Histopathology Department, School and Hospital of Stomatology, Wuhan University, Wuhan, China
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16
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Coskunses FM, Cilasun Ü, Celik Topcu P, Tokuc B. Primary diffuse large B-cell lymphoma of the mandible: A case report. Gerodontology 2020; 37:307-311. [PMID: 32809252 DOI: 10.1111/ger.12470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/30/2020] [Accepted: 03/06/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Lymphomas are a heterogeneous group of malignant neoplasms of lymphocytes and their precursor cells. Lymphoma is seen 3.5% of all intraoral malignancies and is the second most common neoplasm after the squamous cell carcinoma in the head and neck region. Diffuse large B-cell lymphomas (DLBCL), which is a subtype of non-Hodgkin lymphoma, are seen mostly in the paraoral region. CASE PRESENTATION An 82-year-old woman was referred with a localised swelling of the mandibular buccal mucosa for 3 months. Excisional biopsy revealed the diagnosis of DLBCL in the mandible and chemotherapy regimen started immediately. However, patient died during treatment. CONCLUSIONS Non-Hodgkin's lymphomas would be late- or misdiagnosed in the perioral region that may result poor prognosis.
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Affiliation(s)
- Fatih Mehmet Coskunses
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Kocaeli University, Kocaeli, Turkey
| | - Ülkem Cilasun
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cyprus Health and Social Sciences University, Morphou, Cyprus
| | - Pinar Celik Topcu
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Kocaeli University, Kocaeli, Turkey
| | - Berkay Tokuc
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Kocaeli University, Kocaeli, Turkey
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17
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França SR, Fernandes JDL, Alves RL, Chaves FN, de Oliveira DHIP, da Silva Sampieri MB. Diagnostic challenge of T-cell MALT lymphoma in oral cavity. Oral Oncol 2020; 108:104934. [PMID: 32741729 DOI: 10.1016/j.oraloncology.2020.104934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 07/22/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
Abstract
Mucosa-associated lymphoid tissue lymphoma (MALT) is a neoplasm of B cells from the extranodal marginal zone and a non-Hodgkin lymphoma subtype. We report a case of MALT lymphoma in the hard palate in a 74-year-old woman with the previous diagnosis of lymphoid hyperplasia. The intetion about this letter is to show the appropriate clinical conduct and the diagnostic challenge about this pathlogy in oral cavity, stressing the importance to incisional biopsy and immunohistochemical analysis to guide the right diagnostic of this rare lesion.
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18
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Zhang XY, Wang ZM. Relevance on the diagnosis of malignant lymphoma of the salivary gland. World J Clin Cases 2020; 8:2717-2726. [PMID: 32742982 PMCID: PMC7360714 DOI: 10.12998/wjcc.v8.i13.2717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/13/2020] [Accepted: 06/10/2020] [Indexed: 02/05/2023] Open
Abstract
Malignant lymphoma originates from the lymphohematopoietic system. It can occur in any lymphoid tissue. Malignant lymphoma of the salivary gland is rare, but its incidence has increased in recent years. Its clinical- presentations are non-specific, and it is often manifested as a painless mass in a salivary gland, which can be accompanied by multiple swollen cervical lymph nodes. Confirmation of the diagnosis before an invasive procedure is difficult. Clinically, malignant lymphoma of the salivary gland tends to be misdiagnosed, leading to an inappropriate treatment plan and the ultimate delay in the optimal treatment of the disease. This article reviews the pathogenesis, clinical features, imaging findings, diagnosis, treatment and prognosis of malignant lymphoma of the salivary gland.
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Affiliation(s)
- Xin-Yue Zhang
- Department of Stomatology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Zhi-Ming Wang
- Department of Stomatology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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19
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Ajani MA, Nwanji ID, Olaniran FO, Ogun GO, Okolo CA, Akinmoladun VI. Histopathology of Head and Neck Lymphomas in Ibadan. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2020; 10:40-44. [PMID: 35720949 PMCID: PMC9202602 DOI: 10.4103/jwas.jwas_39_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Lymphomas are a heterogeneous group of tumors of lymphoid tissue in which there is a malignant proliferation of cells of the lymphatic system. They are the most frequent nonepithelial malignancy in the head and neck region. OBJECTIVES The aim of this study was to evaluate the histological pattern of the disease in the head and neck region and trends in presentation seen in our center. MATERIALS AND METHODS This was a retrospective study of cases of head and neck lymphoma (HNL) seen in the Pathology Department of the University College Hospital Ibadan, Nigeria over a period of 37 years (1981-2017). Information extracted from the records included the sociodemographics of the patients, tumor location, and histological type among others. Data were analyzed and results were presented as frequencies and percentages. RESULTS There were a total of 373 cases of histologically and/or cytologically diagnosed HNL seen during the study period (an average of 10 cases per year). The mean age of patients was 33.5 ± 21.9 years with male:female ratio of 1.6:1. Most HNL were non-Hodgkin's lymphomas (NHL), accounting for 91% of cases. Nodal disease was seen in 39% of cases. The bone (prominently, the jaws) predominated (25%) in extranodal lesions. Burkitt's lymphoma was the most common specific subtype of NHL, occurring in 25.5% of cases. CONCLUSION There has been an apparent upward trend in the prevalence of HNL over the past four decades, although other parameters such as age and sex predilection appear unaffected. Factors responsible for this trend need to be interrogated and ascertained.
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Affiliation(s)
- Mustapha A. Ajani
- Department of Pathology, University College Hospital, Ibadan, Oyo state, Nigeria
- Department of Pathology, College of Medicine, University of Ibadan, Ibadan, Oyo state, Nigeria
| | | | - Folaranmi O. Olaniran
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Oyo state, Nigeria
| | - Gabriel O. Ogun
- Department of Pathology, University College Hospital, Ibadan, Oyo state, Nigeria
- Department of Pathology, College of Medicine, University of Ibadan, Ibadan, Oyo state, Nigeria
| | - Clement A. Okolo
- Department of Pathology, University College Hospital, Ibadan, Oyo state, Nigeria
- Department of Pathology, College of Medicine, University of Ibadan, Ibadan, Oyo state, Nigeria
| | - Victor I. Akinmoladun
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Oyo state, Nigeria
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20
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Tseng CH, Wang WC, Chen CY, Hsu HJ, Chen YK. Clinical manifestations of oral lymphomas - Retrospective study of 15 cases in a Taiwanese population and a review of 592 cases from the literature. J Formos Med Assoc 2020; 120:361-370. [PMID: 32505589 DOI: 10.1016/j.jfma.2020.05.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/05/2020] [Accepted: 05/17/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND/PURPOSE Due to the rarity of oral lymphoma (OL), we aimed to evaluate the clinical features of OL and discuss these findings in light of the literature. METHODS English language literature (1980-2019) related to OL was searched in two electronic databases. Patients (2000-2019) diagnosed with OL were also selected from the database of the Oral Pathology Department in our institution. The clinical features, radiographic appearance, and histopathological diagnosis in these selected cases from publications and our institution were then analyzed. RESULTS 607 cases of OL (15 in our institution and 592 from literature) in patients aged between 0 and 92 years (average, 51.8 years) with a male to female ratio of 1.6:1 were included. The most common diagnosis was diffuse large B-cell lymphoma (n = 205), followed by Burkitt lymphoma (n = 72) and T-cell lymphoma (n = 37). The most frequent site was the gingiva, followed by palate, maxilla, mandible, tongue and buccal mucosa. The most frequent symptoms were swelling, ulceration, paresthesia, mobile tooth and pain. Radiographic findings included ill-defined osteolytic lesion, thickening of the periodontal ligament, loss of lamina dura and tooth displacement. CONCLUSION Despite the rarity of extranodal lymphomas in oral cavity, their occurrence may be part of disseminated disease. Detailed history-taking, clinical and imaging examination and awareness of the patient's signs and symptoms are important for early diagnosis and an improved prognosis. The current data form a useful basis for clinical investigation and teaching regarding lymphoma occurring in the oral cavity.
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Affiliation(s)
- Chih-Huang Tseng
- Division of Oral Pathology & Maxillofacial Radiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Oral & Maxillofacial Imaging Center, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Chen Wang
- Division of Oral Pathology & Maxillofacial Radiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Oral & Maxillofacial Imaging Center, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Yi Chen
- Division of Oral Pathology & Maxillofacial Radiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Oral & Maxillofacial Imaging Center, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Han-Jen Hsu
- Division of Oral & Maxillofacial Surgery, Kaohsiung Medical University Hospital Kaohsiung, Taiwan
| | - Yuk-Kwan Chen
- Division of Oral Pathology & Maxillofacial Radiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Oral & Maxillofacial Imaging Center, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Oral & Maxillofacial Surgery, Kaohsiung Medical University Hospital Kaohsiung, Taiwan.
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21
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Singh R, Shaik S, Negi BS, Rajguru JP, Patil PB, Parihar AS, Sharma U. Non-Hodgkin's lymphoma: A review. J Family Med Prim Care 2020; 9:1834-1840. [PMID: 32670927 PMCID: PMC7346945 DOI: 10.4103/jfmpc.jfmpc_1037_19] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 12/05/2019] [Accepted: 02/19/2020] [Indexed: 01/18/2023] Open
Abstract
Lymphomas constitute the third most common neoplasm in head and neck region arising from the lymphoreticular system. Malignant lymphomas are divided into Hodgkin's disease and non-Hodgkin's lymphoma (NHL). NHL comprises approximately 5% of head and neck malignancies and displays a wide range of appearances comparable with Hodgkin's disease. Hodgkin's and non-Hodgkin's lymphomas are seen in the head and neck region, but extranodal disease, with or without lymph node involvement, is more common among NHL patients. Extranodal involvement includes the areas such as Waldeyer's ring (i.e., the tonsils, pharynx, and base of the tongue), salivary glands, orbit, paranasal sinuses, and thyroid glands. There are several classification systems for categorizing NHL out of which WHO classification for lymphoid neoplasms is mostly followed. This review describes the pathogenesis of NHL and explains some of the important NHL (Marginal zone B-cell Lymphoma, follicular lymphoma, mantle cell lymphoma).
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Affiliation(s)
- Rohit Singh
- Lecturer, Department of Prosthodontics, Crown Bridge and Implantology, Patna Dental College and Hospital, Patna, Bihar, India
| | - Shabana Shaik
- Postgraduate Student, Department of Oral Medicine and Radiology, The Oxford Dental College, Bangalore, Karnataka, India
| | - Bhupender Singh Negi
- Senior Resident, Department of Oral Medicine AND Radiology, Government Dental College Kottayam, Kerala, India
| | - Jagadish Prasad Rajguru
- Professor and HOD, Department of Oral and Maxillofacial Pathology, Hi-Tech Dental College and Hospital, Bhubaneswar, Odisha, India
| | - Pankaj Bajirao Patil
- Assistant Professor, Department of Oral and Maxillofacial Surgery School of Dental Sciences, Krishna Institute of Medical Sciences, Deemed to be University, Karad, Maharashtra, India
| | - Anuj Singh Parihar
- Reader, Department of Periodontology, People's Dental Academy, Bhopal, Madhya Pradesh, India
| | - Uma Sharma
- Private Practitioner and Consultant Orthodontist, New Delhi, India
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22
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Epstein-Barr Virus-Positive Diffuse Large B-Cell Lymphoma, Not Otherwise Specified, in the Oral Cavity. J Craniofac Surg 2019; 30:e259-e262. [DOI: 10.1097/scs.0000000000005302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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23
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Mortha N, Majumdar S, Uppala D, Kotina S. Lymphoma in an extraction socket. J Oral Maxillofac Pathol 2019; 23:12-16. [PMID: 30967716 PMCID: PMC6421927 DOI: 10.4103/jomfp.jomfp_215_18] [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] [Indexed: 11/04/2022] Open
Abstract
Non-Hodgkin's lymphoma (NHL) is a lymphoproliferative malignancy that can involve both lymph node and lymphoid organs as well as extranodal organs and tissues. The aim of presenting this case of NHL is to highlight the suspicion of its occurrence in the region of unhealed extraction sockets and the significance of its awareness. NHL can be presented in various forms; therefore, a thorough knowledge regarding this malignancy is essential for arriving at the earliest possible diagnosis and therapy for the patient.
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Affiliation(s)
- Neeharika Mortha
- Department of Oral and Maxillofacial Pathology, GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Sumit Majumdar
- Department of Oral and Maxillofacial Pathology, GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Divya Uppala
- Department of Oral and Maxillofacial Pathology, GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Sreekanth Kotina
- Department of Oral and Maxillofacial Pathology, GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
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24
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Rodrigues‐Fernandes CI, Souza LL, Santos‐Costa SFD, Pontes HAR, Almeida OP, Vargas PA, Henao JR, Rahimi S, Brennan PA, Fonseca FP. Clinicopathological analysis of oral diffuse large B‐cell lymphoma, NOS: A systematic review. J Oral Pathol Med 2018; 48:185-191. [DOI: 10.1111/jop.12802] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | - Lucas Lacerda Souza
- Service of Oral Pathology João de Barros Barreto University Hospital Federal University of Pará Belém Brazil
| | | | | | - Oslei Paes Almeida
- Department of Oral Diagnosis Piracicaba Dental School University of Campinas Piracicaba Brazil
| | - Pablo Agustin Vargas
- Department of Oral Diagnosis Piracicaba Dental School University of Campinas Piracicaba Brazil
| | | | - Siavash Rahimi
- Department of Histopathology Queen Alexandra Hospital Portsmouth UK
| | - Peter A. Brennan
- Department of Oral and Maxillofacial Surgery Queen Alexandra Hospital Portsmouth UK
| | - Felipe Paiva Fonseca
- Department of Oral Diagnosis Piracicaba Dental School University of Campinas Piracicaba Brazil
- Department of Oral Surgery and Pathology School of Dentistry Universidade Federal de Minas Gerais Belo Horizonte Brazil
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Extranodal lymphoma arising within the maxillary alveolus: a systematic review. Oral Radiol 2018; 34:113-126. [PMID: 30147235 DOI: 10.1007/s11282-017-0309-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 10/19/2017] [Indexed: 11/27/2022]
Abstract
Objectives Extranodal lymphomas affecting the head and neck infrequently arise within the jaw bones. Although clinical examination and conventional radiography may initially suffice for such lesions arising within the mandible, those arising within the maxillary alveolus generally require cross-sectional imaging because of the complex anatomy of this region. This study was performed to determine the prevalence, demographic characteristics, and clinical presentations of these lesions and the imaging modalities used for their diagnosis. Study design A systematic review (SR) on case series and another SR on case reports were performed to investigate the demographic, clinical, and radiological features of extranodal lymphomas arising within the maxillary alveolus. Results Most case series were derived from just four nations, whereas the case reports were derived from a wider range of ethnicities. The more detailed case reports significantly reported at least one imaging modality. Most patients were aware of their lesions for nearly 2 months before presentation. The most frequent symptom was swelling. Most case reports included a provisional diagnosis, the most frequent of which was dental infection followed by squamous cell carcinoma. Discussion Extranodal lymphomas arising within the maxillary alveolus were sufficiently frequent in four communities to be reported in two or more case series, and the occasional single case report indicated that such lesions are more widespread globally. Although the SR on case series revealed differences in the relative period prevalence and maxillary/mandibular ratio, the SR on case reports revealed details of the clinical presentation and imaging modalities used.
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Abdelwahed Hussein MR. Non-Hodgkin’s lymphoma of the oral cavity and maxillofacial region: a pathologist viewpoint. Expert Rev Hematol 2018; 11:737-748. [DOI: 10.1080/17474086.2018.1506326] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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27
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Sánchez-Romero C, Pontes HAR, Pontes FSC, Rocha AC, Carlos R, Rendón JC, de Almeida OP, Fonseca FP. Acute lymphoblastic leukemia/lymphoma of the oral and maxillofacial region. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:152-164. [DOI: 10.1016/j.oooo.2018.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/02/2018] [Accepted: 01/16/2018] [Indexed: 12/13/2022]
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Abstract
RATIONALE Lymphomas are the second most common non-epithelial malignant tumors in the oral and maxillofacial region. Non-Hodgkin's lymphoma (NHL) develops at extranodal sites, and cases involving the maxilla account for less than 1% of all NHLs. We describe a case of diffuse large B-cell lymphoma (DLBCL) in the maxilla, and highlight the clinical signs, symptoms, differential diagnosis, and appropriate treatment of DLBCL in the oral cavity and maxillofacial region. PATIENT CONCERNS A 67-year-old woman was admitted to our surgical department with pain and swelling in her right upper posterior teeth for about six months. She was previously misdiagnosed with periodontal disease and had a history of tooth extraction. DIAGNOSES Computed tomography (CT) scan revealed extensive osteolysis in the right posterior part of the maxilla with enhanced neoplasm. A solid mass was found upon incisional biopsy, and immunohistochemistry confirmed the diagnosis of DLBCL. INTERVENTIONS The patient was treated with six courses of rituximab, cyclophosphamide, pirarubicin, vincristine, and prednisolone (R-CHOP), followed by external irradiation treatment. OUTCOMES The treatment was well tolerated, and the patient is presently alive after two years of follow-up. LESSONS Non-specific symptoms, such as unclear primary dental pain and unresolved periapical swelling, can make an accurate diagnosis of DLBCL difficult, which frequently lead to delayed diagnosis. A CT or cone beam computed tomography (CBCT) scan of the maxilla and immunohistochemical staining of the biopsy specimen is recommended. Combination therapy including radiotherapy and chemotherapy is the optimal treatment for NHL.
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Affiliation(s)
| | | | | | - Lang Lei
- Department of Pathology, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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29
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Pereira AAC, Ferreira CB, Hanemann JAC, Paranaiba LMR, Pereira PPI, Rodrigues-Fernandes CI, Sánchez-Romero C, de Almeida OP, Fonseca FP. Oral Manifestation of Lymphomatoid Granulomatosis. Head Neck Pathol 2018. [PMID: 29542064 PMCID: PMC6513961 DOI: 10.1007/s12105-018-0910-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Lymphomatoid granulomatosis (LYG) is a rare B-cell lymphoproliferative disorder driven by Esptein-Barr virus (EBV) that most commonly affects the lungs, although extra pulmonary sites like the central nervous system, skin, liver and kidney can also be involved. It is microscopically characterized by an angiocentric and angiodestructive growth pattern, predominantly composed by small T-cells, although a smaller population of atypical large B-cells is considered the true neoplastic component. Oral cavity involvement of LYG has rarely been described and the diagnosis of this neoplasm is very difficult. The aim of this report is to present a rare case of LYG affecting an 86-year-old female patient that was diagnosed due to an extensive, ulcerated and painful oral lesion affecting the hard palate. Detailed microscopic evaluation together with a large immunohistochemical study were necessary to achieve the correct diagnosis of LYG.
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Affiliation(s)
| | | | | | - Livia Maris Ribeiro Paranaiba
- Department of Pathology and Parasitology, Institute of Biomedical Sciences, Federal University of Alfenas, Alfenas, Brazil
| | | | | | - Celeste Sánchez-Romero
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Oslei Paes de Almeida
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Felipe Paiva Fonseca
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil ,Department of Oral Surgery and Pathology, School of Dentistry, Federal University of Minas Gerais, Av. Antônio Carlos 6627, Pampulha, Belo Horizonte, 31270-901 Brazil
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30
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Vo Quang S, Sicard L, Samama M, Benslama L, Goudot P. Mandibular lymphoma. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 119:49-51. [DOI: 10.1016/j.jormas.2017.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 09/04/2017] [Accepted: 10/02/2017] [Indexed: 11/28/2022]
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Montaner S, Weingertner N, Ledoux MP, Chenard MP, Lutz JC, Bornert F. Follicular Lymphomas of Oral Region Treated by Rituximab Monotherapy: About Two Cases. J Hematol 2018; 7:23-28. [PMID: 32300407 PMCID: PMC7155859 DOI: 10.14740/jh346w] [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: 10/03/2017] [Accepted: 10/23/2017] [Indexed: 11/17/2022] Open
Abstract
Lymphomas represent the second most common malignant lesions of the head and neck. Among them, follicular lymphomas (FLs) are the second most frequent B-cell non-Hodgkin’s lymphomas. However, their incidence is rare in the oral cavity. We describe here two cases of FL with initial intra-oral presentation. The first patient was 81 years old and presented a palatal hyperplasia, covering the posterior edge of her dental removable prosthesis. After surgical excision of the lesion, the pathological diagnosis was an extra-nodal low-grade follicular lymphoma. Medical imaging assessment found a widespread but non-bulky involvement. The second patient was 38 years old and referred for asymptomatic swelling of the lower vestibule evolving for 4 months. Surgical exploration revealed a cheek lymphadenopathy infiltrated by a grade 3 FL; this patient did not have any other localization. Both patients were treated by a rituximab monotherapy with excellent response after 2 years of follow-up. Most of the time, FL affecting the oral cavity presenting as unspecific swelling, can mimic other frequent and benign oral lesions. In the absence of biopsy, both diagnosis and proper onco-hematological management may be delayed. The introduction of monoclonal antibody rituximab represents a major advance in the management of FL: it can be used as monotherapy or may be combined with chemo-immunotherapy according to histological grading, initial staging (extent, tumor mass or bulk), age and co-morbidities. These two observations show the importance of an early diagnosis regarding a chronic lesion in the oral cavity. Painless lymphadenopathy, asymptomatic swelling, aspecific mucosal lesions, or subprosthetic lesions should draw attention of any oral specialist.
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Affiliation(s)
- Sylvain Montaner
- Dental Faculty, University of Strasbourg, 8 rue Sainte Elisabeth, F-67000 Strasbourg, France.,Oral Surgery and Oral Medecine Unit, Dental Clinic, Hopital Civil, University Hospital of Strasbourg, 1 place de l'Hopital, F-67000 Strasbourg, France
| | - Noelle Weingertner
- Department of Pathology, Hopital de Hautepierre, University Hospital of Strasbourg, 1 avenue Moliere, F-67000 Strasbourg, France
| | - Marie-Pierre Ledoux
- Department of Hematology, Hopital de Hautepierre, University Hospital of Strasbourg, 1 avenue Moliere, F-67000 Strasbourg, France.,Faculty of Medicine, University of Strasbourg, 4 rue Kirschleger, F-67000 Strasbourg, France
| | - Marie-Pierre Chenard
- Department of Pathology, Hopital de Hautepierre, University Hospital of Strasbourg, 1 avenue Moliere, F-67000 Strasbourg, France.,Faculty of Medicine, University of Strasbourg, 4 rue Kirschleger, F-67000 Strasbourg, France
| | - Jean-Christophe Lutz
- Faculty of Medicine, University of Strasbourg, 4 rue Kirschleger, F-67000 Strasbourg, France.,Stomatology Maxillo-Facial and Plastic Surgery Department, Hopital Civil, University Hospital of Strasbourg, 1 place de l'Hopital, F-67000 Strasbourg, France.,INSERM (French National Institute of Health and Medical Research), "Osteoarticular and Dental Regenerative Nanomedicine" Laboratory, UMR 1109, Faculte de Medecine, FMTS, F-67085 Strasbourg Cedex, France
| | - Fabien Bornert
- Dental Faculty, University of Strasbourg, 8 rue Sainte Elisabeth, F-67000 Strasbourg, France.,Oral Surgery and Oral Medecine Unit, Dental Clinic, Hopital Civil, University Hospital of Strasbourg, 1 place de l'Hopital, F-67000 Strasbourg, France.,INSERM (French National Institute of Health and Medical Research), "Osteoarticular and Dental Regenerative Nanomedicine" Laboratory, UMR 1109, Faculte de Medecine, FMTS, F-67085 Strasbourg Cedex, France
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Abstract
Purpose This meta-analysis aimed to review the published outcomes of parotid
non-Hodgkin lymphoma (NHL) pertaining to different treatment modalities. Materials and Methods A total of 48 journal articles published between 1993 and 2015, comprising
742 cases of parotid NHL, were initially evaluated. In total, 108 patients
from 12 studies who had sufficient data for analysis, including age, tumor
histopathology, treatment modality, and outcome at final follow-up, were
included. Patients were randomly assigned to different categories on the
basis of histopathology and treatment modality. Groups were compared using
Kaplan-Meier survival curve analysis and the Mann-Whitney U
test. Results Log-rank tests demonstrated that for early-stage (I and II) parotid NHL of
all histopathology variants, radiation therapy significantly improved the
survival rate versus chemotherapy (P = .043), as well as
combined treatment with chemotherapy and radiation therapy
(P = .023). For early-stage diffuse large B-cell
lymphoma, combined treatment significantly improved survival versus single
treatment (P = .028). No treatment was received by seven
patients with early-stage mucosa-associated lymphoid tissue lymphoma after
undergoing parotidectomy. When the clinical outcomes of these patients were
compared with those of other patients with the same histology who underwent
further treatment, no significant differences were noted in survival
outcomes. Conclusion Radiation therapy seems to be a valid treatment of early-stage parotid NHL.
However, for diffuse large B-cell lymphoma, survival was higher with
combined treatment versus single treatment. For early-stage parotid
mucosa-associated lymphoid tissue lymphoma, complete excision of the tumor
through superficial parotidectomy may have similar survival outcome.
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Affiliation(s)
- Basem Jamal
- Basem Jamal, King Abdulazziz University, Jeddah, Makkah, Saudi Arabia
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33
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A distinctive subgroup of oral EBV+ B-cell neoplasm with polymorphous features is potentially identical to EBV+ mucocutaneous ulcer. Hum Pathol 2017; 69:129-139. [PMID: 28993276 DOI: 10.1016/j.humpath.2017.09.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 09/19/2017] [Accepted: 09/29/2017] [Indexed: 12/11/2022]
Abstract
Epstein-Barr virus-positive mucocutaneous ulcer (EBVMCU) is a newly recognized provisional entity included in mature B-cell neoplasm in the latest 2016 World Health Organization Classification. It has a self-limited growth potential with a high predilection for oral cavities and occurs in age-related or iatrogenic immunodeficiency with indolent clinical courses. However, it shares histological features with EBV-positive diffuse large B-cell lymphoma (DLBCL), and this often leads to diagnostic challenges and controversies in patients with an oral EBV-positive B-cell neoplasm. The aim of this study was to better characterize and comprehend the pathophysiology of DLBCL and EBVMCU in the oral cavity. We conducted clinicopathologic and recurrent gene mutation analysis of 49 cases (14 EBV positive, 35 EBV negative), including cases diagnosed as DLBCL or B-cell lymphoproliferative disorders with high-grade morphology in the oral cavity. All EBV-positive cases matched the criteria of EBVMCU, with significantly earlier clinical stages than the EBV-negative group (P=.0006). Besides, histological analysis showed that all EBV-positive cases presented polymorphous features, whereas 91.4% (32/35) of the EBV-negative cases showed diffuse and monotonous proliferation (P<.0001). Furthermore, EBV-positive cases presented favorable clinical outcomes without disease-related death or recurrence. Gene mutation analysis (MYD88, CD79A, CD79B, CARD11, and EZH2) revealed that 33.3% (9/27) of EBV-negative cases harbored at least 1 gene mutation, whereas no gene mutation was observed in the EBV-positive group (0/11). These results suggest that oral EBV-positive B-cell lymphoid proliferation with polymorphous features often fulfill the criteria for EBVMCU, with clinicopathologically and genetically distinctive properties.
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34
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Affiliation(s)
- Christina McCord
- Division of Oral Pathology, Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, HSA 418A, London, Ontario N6A 5C1, Canada.
| | - Lisa Johnson
- Department of Oral and Maxillofacial Sciences, Faculty of Dentistry, Dalhousie University, 5981 University Avenue, Room 5124, PO Box 15000, Halifax, Nova Scotia B3H 4R2, Canada
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35
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Alli N, Meer S. Head and neck lymphomas: A 20-year review in an Oral Pathology Unit, Johannesburg, South Africa, a country with the highest global incidence of HIV/AIDS. Oral Oncol 2017; 67:17-23. [PMID: 28351573 DOI: 10.1016/j.oraloncology.2017.01.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/29/2016] [Accepted: 01/27/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Non-Hodgkin lymphoma occurs with increasing frequency in HIV/AIDS. As South Africa has the highest incidence of HIV/AIDS worldwide, an epidemiologic study of this nature provides insight into head and neck lymphomas in a defined South African population. This retrospective review evaluated frequency and clinico-pathologic characteristics of patients diagnosed with head and neck lymphoma at the Oral Pathology Department, University of Witwatersrand between 1993 and 2012. MATERIALS AND METHODS Histopathology reports of patients with head and neck lymphomas (n=504) were reviewed. Demographic (age, gender), clinical (site and size of tumour), laboratory and histological parameters were recorded. RESULTS There were 504 patients with head and neck lymphomas. The mean age was 40.4years. The male:female ratio was 1.1:1. The cervical lymph node was the most common anatomic site (115 cases) and the maxilla (60 cases) the most common extranodal site. Plasmablastic lymphoma (159 cases) was the most common histologic subtype, seen more frequently as a result of its strong association with HIV/AIDS. The most common Hodgkin's lymphoma was the nodular sclerosing variant (21 cases). Of the head and neck lymphomas in patients with a known HIV status, 56% had plasmablastic lymphoma, 43.9% diffuse large B cell lymphoma and 25% Burkitt lymphoma. CONCLUSION There is an increase in head and neck lymphoma frequency, contrary to that found in Western countries. The high HIV prevalence in certain lymphomas provides strong indication of the role of HIV/AIDS in pathogenesis of lymphomas. This study serves as a baseline for future studies, especially in South Africa.
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Affiliation(s)
- Nasreen Alli
- Department of Oral Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Shabnum Meer
- Department of Oral Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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36
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Abstract
Lymphadenopathy is a common clinical finding in a patient seeking oral health care. It may be in a localized, limited, or generalized form. Malignancies, infections, autoimmune disorders, iatrogenic, and other miscellaneous conditions are considered as the causes for cervical lymphadenopathy. Unexplained cervical lymphadenopathy is a cause of concern for physician and patient because sometimes it could be the manifestation of an underlying malignancy. However, a methodological approach to lymphadenopathy can disclose the accurate diagnosis causing minimal discomfort for the patient and in a short time. This paper reports the significance of cervical lymph node examination and ensuing investigations, which led to a diagnosis of non-Hodgkins lymphoma.
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Affiliation(s)
- Athira Aruna Ramadas
- Department of Oral Medicine and Radiology, Amrita School of Dentistry, Kochi, Kerala, India
| | - Renju Jose
- Department of Oral Medicine and Radiology, Amrita School of Dentistry, Kochi, Kerala, India
| | - Beena Varma
- Department of Oral Medicine and Radiology, Amrita School of Dentistry, Kochi, Kerala, India
| | - Marina Lazar Chandy
- Department of Oral Medicine and Radiology, Amrita School of Dentistry, Kochi, Kerala, India
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Teh CS, Jayalakshmi P, Chong SY. Waldeyer ring lymphoma: a case series. EAR, NOSE & THROAT JOURNAL 2016; 93:E22-5. [PMID: 25255354 DOI: 10.1177/014556131409300905] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We encountered a patient with a tongue base lymphoma that we initially diagnosed as a lingual tonsil in view of its benign appearance. We established the correct diagnosis of Waldeyer ring lymphoma by histology. This case led us to conduct a study of all cases of Waldeyer ring lymphoma that had been treated at our center during a 10-year period. We retrospectively examined our case records and found 35 such cases. From this group, we excluded 5 cases because of incomplete data. Thus our final study group was made up of 30 patients-14 males and 16 females, aged 14 to 76 years (mean: 51.6; median 54). The primary presenting signs and symptoms were dysphagia (n = 17 [57%]), a neck mass (n = 7 [23%]), nasal symptoms (n = 5 [17%]), and pain (n = 1 [3%]). Only 4 patients (13%) had B symptoms. A total of 20 patients (67%) presented with tonsillar involvement, 8 (27%) with nasopharyngeal involvement, 1 (3%) with tongue base lymphoma, and 1 with anterior tongue involvement. Most patients (77%) presented at an early stage. Histologically, 25 patients (83%) had high-grade diffuse large B-cell lymphoma, 4 (13%) had T-cell lymphoblastic lymphoma, and 1 (3%) had follicular lymphoma. Twenty-one patients (70%) were treated with chemotherapy, 4 (13%) received adjuvant chemotherapy with either radiotherapy or surgery, 3 (10%) resorted to other forms of treatment (primarily traditional remedies), and 2 (7%) declined treatment altogether. There were 14 patients (47%) alive at the end of the study period.
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Affiliation(s)
- Carren S Teh
- Department of Otorhinolaryngology, Sungai Buloh Hospital, Sungai Buloh, 47000 Selangor, Malaysia.
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Yonal-Hindilerden I, Hindilerden F, Arslan S, Turan-Guzel N, Dogan IO, Nalcaci M. Primary B-Cell Mucosa-Associated Lymphoid Tissue Lymphoma of the Hard Palate and Parotid Gland: Report of One Case and Review of the Literature. J Clin Med Res 2016; 8:824-830. [PMID: 27738485 PMCID: PMC5047022 DOI: 10.14740/jocmr2733w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2016] [Indexed: 12/15/2022] Open
Abstract
A 61-year-old woman was admitted to our hospital with an ulcerated palate mass and swelling of the right parotid gland. Incisional biopsy from the hard palate revealed an extranodal marginal zone B-cell lymphoma, also called mucosa-associated lymphoid tissue (MALT) lymphoma. Final diagnosis was MALT lymphoma of the parotid gland with concomitant involvement of an extremely seldom site of involvement: the hard palate. To our knowledge, this report illustrates the first case of MALT lymphoma of the hard palate and parotid gland without an underlying autoimmune disease. Rituximab-based combination regimen (R-CHOP) provided complete remission with total regression of mass lesions at the hard palate and parotid gland. At 44-month follow-up, there is no disease relapse. We adressed the manifestations and management of MALT lymphoma patients with involvement of salivary gland and oral cavity.
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Affiliation(s)
- Ipek Yonal-Hindilerden
- Division of Hematology, Department of Internal Medicine, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Fehmi Hindilerden
- Hematology Clinic, Istanbul Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Serkan Arslan
- Radiology Clinic, Istanbul Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Nalan Turan-Guzel
- Department of Pathology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Ibrahim Oner Dogan
- Department of Pathology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Meliha Nalcaci
- Division of Hematology, Department of Internal Medicine, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
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Patini R, Coviello V, Riminucci M, Corsi A, Cicconetti A. Early-stage diffuse large B-cell lymphoma of the submental region: a case report and review of the literature. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/ors.12221] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- R. Patini
- Department of Surgical Sciences for Head and Neck Diseases; School of Dentistry; Catholic University of Sacred Heart; Rome Italy
| | - V. Coviello
- Department of Oral and Maxillofacial Sciences; School of Dentistry; ‘Sapienza’ University of Rome; Rome Italy
| | - M. Riminucci
- Department of Sperimental Medicine and Pathology; ‘Sapienza’ University of Rome; ‘Umberto I’ Polyclinic in Rome; Rome Italy
| | - A. Corsi
- Department of Sperimental Medicine and Pathology; ‘Sapienza’ University of Rome; ‘Umberto I’ Polyclinic in Rome; Rome Italy
| | - A. Cicconetti
- Department of Oral and Maxillofacial Sciences; School of Dentistry; ‘Sapienza’ University of Rome; Rome Italy
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40
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Kumar MS, Gannepalli A, Chandragiri A, Amarnath K. Diffuse Large B-Cell Lymphoma of Maxilla - A Case Report of Late Relapse. J Clin Diagn Res 2016; 10:ZD12-4. [PMID: 27190967 DOI: 10.7860/jcdr/2016/16139.7695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 02/03/2016] [Indexed: 11/24/2022]
Abstract
Diffuse Large B Cell Lymphomas (DLBCL) encompasses a heterogeneous group of tumors that together constitute the commonest of all Non Hodgkin Lymphoma (NHL) and the proclivity of DLBCL to oral cavity is unknown. They mostly arise from soft tissues as asymptomatic lesions, mostly without 'B' symptoms and involvement of jaw bones is uncommon. Most studies and case reports of oral DLBCL's are based on, manifestation of primary extra-nodal disease or a component of a disseminated disease process involving regional lymph nodes. Many investigators have proposed that patients with this cell type who maintain a complete response for 24 consecutive months are cured because late relapses seldom occur. With advances in treatment modalities, many patients with NHL become long-term survivors and the risk of relapses or second tumors are of growing concern. We present a case of DLBCL which relapsed after five years of initial lesion in a 41 year old female patient and presented as a nonspecific bilateral anterior maxillary radiolucency. DLBCL usually express pan-B markers with small percentage expressing T-cell markers. Few rare cases of DLBCL have shown CD3 expression, which is a most sensitive T-cell marker which was focally expressed in the present case.
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Affiliation(s)
- Medikonda Suresh Kumar
- Professor and Head of Deparment, Department of Oral and Maxillofacial Surgery, Meghana Institute of Dental Sciences , Nizamabad, Telangana, India
| | - Ashalata Gannepalli
- Professor, Department of Oral Maxillofacial Pathology and Microbiology, Panineeya Mahavidyalaya Institute of Dental Sciences and Research Centre , Hyderabad, Telangana, India
| | - Anuradha Chandragiri
- Post-graduate Student, Department of Oral Maxillofacial Pathology and Microbiology, Panineeya Mahavidyalaya Institute of Dental Sciences and Research Centre , Hyderabad, Telangana, India
| | - Konda Amarnath
- Reader, Department of Oral and Maxillofacial Surgery, Meghana Institute of Dental Sciences , Nizamabad, Telangana, India
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Desai D, Pandit S, Jasphin S, Shetty AS. Human immunodeficiency virus associated plasmablastic lymphoma: A case report. Indian J Dent 2016; 7:144-148. [PMID: 27795651 PMCID: PMC5015567 DOI: 10.4103/0975-962x.186699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Non-Hodgkin's lymphoma (NHL) is the third common malignant lesion of the oral region. Plasmablastic lymphomas are rare, aggressive neoplasms occurring mostly in human immunodeficiency virus (HIV) infected individual which accounts for approximately 2.6% of all NHL. It usually presents as a diffuse growth and with diffuse pattern of histological presentation. It is very difficult to differentiate this lymphoma from other NHL. Immunohistochemical evaluation of various markers is an important criteria of the diagnostic protocol. Here, we describe a case of plasmablastic lymphoma in a 50-year-old female HIV-infected patient. The diagnosis was based on histopathological examination and immunophenotyping.
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Affiliation(s)
- Dinkar Desai
- Department of Oral and Maxillofacial Pathology and Microbiology, AJ Institute of Dental Sciences, Manipal, Karnataka, India
| | - Siddharth Pandit
- Department of Oral and Maxillofacial Pathology and Microbiology, AJ Institute of Dental Sciences, Manipal, Karnataka, India
| | - Shiny Jasphin
- Post-Doctoral Fellow, Melaka Manipal Medical College, Manipal, Karnataka, India
| | - Akhil S Shetty
- Department of Dentistry, Kanachur Medical Hospital and Research Centre, Deralakatte, Mangalore, Karnataka, India
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42
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Akbari ME, Bastani Z, Mokhtari S, Atarbashi Moghadam S. Oral Lymphoma Prevalence in Iranian Population: A Multicenter Retrospective Study. IRANIAN JOURNAL OF CANCER PREVENTION 2015; 8:e4124. [PMID: 26855724 PMCID: PMC4736074 DOI: 10.17795/ijcp-4124] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 11/07/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Oral lymphoma is the second most common malignancy of the head and neck region after malignant epithelial tumors. OBJECTIVES Considering the lack of a multicenter study on the frequency of oral lymphoma in Iran, this study aimed to assess the relative frequency of oral lymphomas in Iran during a 6-year period. MATERIALS AND METHODS This multicenter, retrospective, cross-sectional study was conducted in two phases. In the first phase, cases of oral lymphoma registered in the cancer research center (CRC) of Shahid Beheshti university of medical sciences were extracted. The patient records and pathology reports of these patients were retrieved from the archives and age, sex and microscopic type site of the lesions were evaluated. RESULTS Oral lymphoma accounts for 1% of head and neck malignancies and 8% of all lymphomas. From 2003 to 2008, a total of 437 new cases of oral lymphomas had been registered in the CRC. Diffuse large B-cell lymphoma was found to be the most common form of oral lymphoma in the 6-year period with 240 (54.9%) registered cases. The majority of detected cases were in the 6th and 7th decades of life with a male to female ratio of 1:84. Tonsils were the most common site of occurrence of lymphoma in the oral cavity (77.8%). CONCLUSIONS The age of onset, site of involvement, sex of patients, and histopathological subtype of oral lymphomas in the Iranian population were found to be similar to those of most other countries.
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Affiliation(s)
- Mohammad Esmaeil Akbari
- Cancer Research Centre (CRC), Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | | | - Sepideh Mokhtari
- Department of Oral and Maxillofacial Pathology, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Saede Atarbashi Moghadam
- Department of Oral and Maxillofacial Pathology, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
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Dereci Ö, Ay S, Açıkalın MF, Karagülle M. Ill-fitting dentures as primary presentation of mantle cell lymphoma: A case report and literature review of the primary mantle cell lymphomas of the hard palate. J Oral Maxillofac Pathol 2015; 19:255-9. [PMID: 26604506 PMCID: PMC4611938 DOI: 10.4103/0973-029x.164545] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Mantle cell lymphoma (MCL) is a subtype of B-cell non-Hodgkin's lymphoma seen predominantly in males. Common extra-nodal sites of involvement of MCL are Waldeyer's ring, gastrointestinal tract, bone marrow and peripheral blood. The extra-nodal palatal localization of MCL is quite uncommon. MCL is seen in predominantly older patients, therefore undiagnosed MCL patients are likely to have total prosthesis. In this study, a case of MCL, initially presenting as palatal swelling was reported with relevant literature review and the possible role of dental professionals in the diagnosis of this rare entity was discussed.
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Affiliation(s)
- Ömür Dereci
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Sinan Ay
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Eskişehir Osmangazi University, Eskişehir, Turkey
| | | | - Mustafa Karagülle
- Department of Hematology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
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Alshahrani FAA, Aljabab AS, Motabi IH, Alrashed A, Anil S. Primary Diffuse Large B-cell Lymphoma involving the Mandible. J Contemp Dent Pract 2015; 16:840-4. [PMID: 26581467 DOI: 10.5005/jp-journals-10024-1767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Lymphomas of the oral cavity are rare and typically present as intraosseous lesions that are most commonly diffuse large B-cell type. Diffuse large B-cell lymphoma (DLBCL) is an aggressive B-cell lymphoma histologically characterized by diffuse proliferation of large neoplastic B-lymphoid cells with a nuclear size equal to or exceeding normal histiocytic nuclei. A case of DLBCL of the mandible in an 18 years old male patient is presented. This report discusses this rare malignancy, including clinical presentation, histopathologic features, immunologic profile, treatment and prognosis. Though lymphoma of mandible is rare, it must be considered in differential diagnosis of swellings arising in the region.
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Affiliation(s)
- Faleh Ali A Alshahrani
- Board Resident, Department of Oral and Maxillofacial Surgery, King Fahad Medical City, Riyadh, Saudi Arabia, Phone: +966 56 444 4402, e-mail:
| | - Abdulsalam S Aljabab
- Department of Oral and Maxillofacial Surgery, Head and Neck Surgical Oncology, King Fahad Medical City, Riyadh Saudi Arabia
| | - Ibraheem Hm Motabi
- Department of Adult Hematology and Blood Marrow Transplant, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdullah Alrashed
- Department of Radiology, Unit of Neuroradiology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Sukumaran Anil
- Department of Dental Health, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Klein IP, da Silva AD, Martins MAT, Rados PV, Mengatto CM, Martins MD, Carrard VC. Slow-growing mass and expansive swelling in the maxilla. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:284-90. [PMID: 26159086 DOI: 10.1016/j.oooo.2015.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 04/20/2015] [Accepted: 05/17/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Isadora Peres Klein
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Alessandra Dutra da Silva
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Pantelis Varvaki Rados
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Cristiane Machado Mengatto
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Manoela Domingues Martins
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Vinicius Coelho Carrard
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
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Abe S, Yokomizo N, Kobayashi Y, Yamamoto K. Confirmation of immunoglobulin heavy chain rearrangement by polymerase chain reaction using surgically obtained, paraffin-embedded samples to diagnose primary palate mucosa-associated lymphoid tissue lymphoma: A case study. Int J Surg Case Rep 2015; 10:129-33. [PMID: 25841155 PMCID: PMC4430206 DOI: 10.1016/j.ijscr.2015.03.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 03/23/2015] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Intraoral mucosa-associated lymphoid tissue (MALT) lymphoma is a rare lymphoma that has a good prognosis if diagnosed correctly and treated in time. PRESENTATION OF CASE A 64-year-old woman was referred to our department with asymptomatic swelling of the left hard palate. Computed tomography and magnetic resonance imaging revealed a mass in the left hard palate. We performed a pre-surgery biopsy; however, it was difficult to differentiate MALT lymphoma from other reactive lymphoproliferative disorders via gross or microscopic examination. Although the lesion was completely excised, histological findings did not allow a definitive diagnosis due to an absence of visible monoclonality. We then performed polymerase chain reaction (PCR) using DNA extracted from formalin-fixed, paraffin-embedded surgical samples. Capillary electrophoresis showed monoclonal peaks of immunoglobulin heavy chain gene rearrangement, thus facilitating a definitive diagnosis of MALT lymphoma. DISCUSSION PCR technique is rapid, accurate, and enables a definitive diagnosis without relying on traditional histological or molecular diagnostic techniques, such as Southern blotting. CONCLUSION We suggest that, if histological examination is ambiguous or fresh material is insufficient, PCR can be performed using paraffin-embedded materials to definitively diagnose low-grade lymphomas, such as MALT lymphoma.
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Affiliation(s)
- Shigehiro Abe
- Department of Dentistry and Oral Surgery, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan.
| | - Naoko Yokomizo
- Department of Dentistry and Oral Surgery, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Yutaka Kobayashi
- Department of Dentistry and Oral Surgery, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Kouhei Yamamoto
- Department of Clinical Laboratory, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan; Department of Comprehensive Pathology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
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Rahimi H, Jafarian A, Samadi A, Meamar B, Rahmani S. Evaluation of BCL6 and MUM1 expression in patients with diffuse large B cell lymphoma and their correlations with staging and prognosis in Iran. Asian Pac J Cancer Prev 2015; 16:83-6. [PMID: 25640395 DOI: 10.7314/apjcp.2015.16.1.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diffuse large B-cell lymphoma (DLBCL) is the most common form of non-Hodgkins lymphoma (NHL), accounting for approximately 25% of NHL cases. The aim of this study was to evaluate the association between the BCL6 and MUM1 gene expression and patient prognosis and stage. MATERIALS AND METHODS After ethical approval, in a cross-sectional study, tissue samples of 80 patients with diffuse large B-cell lymphoma were analyzed for BCL6 and MUM1 gene expression. Immunohistochemical staining was performed with division into categories of 0-5%, 5-25%, 26-50%, 51-75% and more than 75%. Other clinical and histological information such as lymph node involvement, T-stage, B symptoms and patient outcome were also recorded. Data were analyzed with SPSS version 16 and a P-value less than 0.05 was considered significant. RESULTS The patient mean age was 46.9±10.5 years (47.6±10.7 and 46.1±9.6 for males and females, respectively). A significant association was seen between lymphoma stage and BCL6 (p=0.045) but not MUM1 expression (p=0.09). However, the latter was associated with mortality (p=0.006) as was also the BCL6 level (p=0.006). CONCLUSIONS : Overexpression of MUM1 and BCL6 is associated with poor prognosis in patients with diffuse large B-cell lymphoma.
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Affiliation(s)
- Hossein Rahimi
- Hematology Oncology Department, Mashhad University of Medical Science, Mashhad, Iran E-mail :
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Georgakopoulou EA, Achtari MD, Evangelou K, Kittas C. Oral non-Hodgkin's lymphoma in a patient with rheumatoid arthritis treated with etanercept and methotrexate. J Clin Exp Dent 2015; 7:e180-2. [PMID: 25810835 PMCID: PMC4368011 DOI: 10.4317/jced.51922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 10/09/2014] [Indexed: 02/06/2023] Open
Abstract
Oral non-Hodgkin’s lymphomas (O-NHLs) are a rare group of diverse lymphoid tissue malignancies and represent less than 5% of the oral cavity malignancies and 2% of all extra-nodal NHLs. Oral-NHLs affect the Waldeyer’s-ring, the salivary glands, the bone of the jaws and the oral mucosa, their clinical appearance is very heterogeneous. Among the risk factors for NHLs are immunosuppression (primary or secondary), autoimmunity and inflammation. O-NHLs share the same risk factors. This case report describes a patient with O-NHL which was possibly linked to the combination of methotrexate and etanercept for the treatment of her rheumatoid arthritis. To our knowledge this is probably among the first cases of O-NHL with possible relation to the use of a Tumor Necrosis Factor (TNF) antagonist biological agent (etanercept). This case could contribute to the sensitization of the dentists for the signs and symptoms of this rare malignancy. It also underlines the need for thorough medical history and medication recording for all the dental patients.
Key words:Lymphoma (oral) methotrexate, etanercept.
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Affiliation(s)
| | - Marina D Achtari
- DDS, MS. Dental Clinic, General Hospital Paidon Pentelis, Athens, Greece
| | - Kostas Evangelou
- MD, PhD, Pathologist. Department of Histology and Embryology, School of Medicine, University of Athens, Greece
| | - Christos Kittas
- MD, PhD, Pathologist. Department of Histology and Embryology, School of Medicine, University of Athens, Greece
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Buchanan A, Kalathingal S, Capes J, Kurago Z. Unusual presentation of extranodal diffuse large B-cell lymphoma in the head and neck: description of a case with emphasis on radiographic features and review of the literature. Dentomaxillofac Radiol 2014; 44:20140288. [PMID: 25421808 DOI: 10.1259/dmfr.20140288] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A very unusual radiographic presentation of non-Hodgkin lymphoma (NHL) involving the maxilla is described. The patient was initially managed with antibiotics prescribed to treat what was thought to represent an odontogenic infection. After unsuccessful antibiotic therapy, the patient was referred to an oral surgery clinic where CBCT was performed. CBCT revealed an atypical generalized sclerosis of the affected bone rather than the usual lytic radiographic pattern associated with NHL. Destruction of the sinus floor with infiltration of the sinus was also present. This rare radio-opaque radiographic presentation is described in detail together with the clinical presentation and histopathological findings. The important radiographic features suggesting malignancy that were present in this atypical case of NHL are discussed. A differential diagnosis highlighting the differences between NHL, osteomyelitis and osteosarcoma is also provided.
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Affiliation(s)
- A Buchanan
- 1 Division of Oral and Maxillofacial Radiology, Department of Oral Health and Diagnostic Sciences, College of Dental Medicine, Georgia Regents University, Augusta, GA, USA
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Laviv A, Sohani AR, Troulis MJ. Lymphoma Mimics Obstructive Sialadenitis: Three Cases. J Oral Maxillofac Surg 2014; 72:1325.e1-11. [DOI: 10.1016/j.joms.2014.02.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Revised: 02/13/2014] [Accepted: 02/18/2014] [Indexed: 12/22/2022]
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