Involvement of the appendix and palate by pleomorphic variant mantle cell lymphoma

Blastoid Mantle Cell Lymphoma of the Palate: Report of a Rare Aggressive Entity and Review of the Literature

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.

Mantle Cell Lymphoma Presenting as Acute Abdominal Syndrome: A Rare Case Report and Literature Review

BACKGROUND

Acute abdominal syndrome can be caused by several possible reasons. The most common causes are perforation of a gastroduodenal ulcer, peritonitis, intestinal obstructions, and perforation of an appendix or fallopian tube. Fever and pain can be caused by an appendicitis or sigmoiditis. Appendiceal lymphoma is a rare disease that is usually found incidentally during appendectomy. Most of the cases are non-Hodgkin's lymphomas. Mantle cell lymphoma is an aggressive B-cell non-Hodgkin's lymphoma with a poorer prognosis than other B-cell lymphomas; thus, a definitive diagnosis is essential.

CASE SUMMARY

A 60-year-old man presented with right lower quadrant pain. He denied any nausea, vomiting or anorexia and was afebrile. The physical examination revealed right lower quadrant abdomen tenderness. The computed tomography scan revealed periappendiceal fatty stranding with a swollen appendix, approximately 2 cm in diameter and prominent paraaortic, portacaval and mesenteric lymph nodes. A diagnosis of acute appendicitis was made, and laparoscopic appendectomy was performed immediately. The subsequent pathological examination revealed severe congestion with lymphoid hyperplasia. The immunohistochemistry stains revealed positive staining for cluster of differentiation (CD) CD20, B-cell lymphoma-2 (Bcl-2), cyclin D1, SRY-box transcription factor-11 (SOX-11), immunoglobulin D (IgD) and immunoglobulin M (IgM) but negative staining for CD3, CD5, CD10 and CD23. 18F-FDG positron emission tomography showed peripheral lymph node involvement, while the bone marrow biopsy showed negative findings. Therefore, a diagnosis of mantle cell lymphoma, Ann Arbor stage IVA, was made. The patient received postoperative combination chemotherapy and remained in a stable condition over a 1-year follow-up period.

CONCLUSION

We report an uncommon case that initially presented as acute appendicitis, for which a final diagnosis of mantle cell lymphoma was made. In comparison with other B-cell lymphomas, mantle cell lymphoma has a poorer prognosis, and positive immunochemical staining of cyclin D1 and SOX-11 is useful for differentiating mantle cell lymphoma from other appendiceal lymphomas and treating patients appropriately. Physicians and nursing staff should be also aware of the associated complications and management in these patients.

Pleomorphic Mantle Cell Lymphoma of the Tongue Base Presenting With Dysphagia

Objectives

We aim to increase awareness of pleomorphic mantle cell lymphoma as a rare, but aggressive form of lymphoma with propensity for recurrence in secondary locations.

Methods

We report the case of a 70-year-old man who presented with chronic post-nasal drainage, dysphagia, and voice changes caused by a tongue base mass.

Results

Partial excision and pathology showed a pleomorphic mantle cell lymphoma, and radiation treatment was completed. A regional recurrence was detected 3 years later and treated with radiation. He had no evidence of disease 17 months after treatment of the recurrence and is under close surveillance.

Conclusions

Pleomorphic mantle cell lymphoma is an aggressive subtype of non-Hodgkin lymphoma that can affect the head and neck. Confirming the diagnosis with immunotyping and genotyping from fresh specimens can guide appropriate treatment and then close clinical follow-up.

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

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.

Mantle cell lymphoma presenting with a tumor of the hard palate

We report a 71-year-old man with a disseminated disease of mantle cell lymphoma (MCL). He initially noticed instability of the maxillary denture due to swelling of the hard palate. Combined positron-emission tomography and computed tomography demonstrated a marked accumulation of fluorodeoxyglucose in the palate. A biopsy of the palatine tumor disclosed diffuse infiltrates of lymphoid cells, which were positive for CD20 and cyclin D1. The peripheral blood contained lymphoma cells with the characteristic immunophenotype, and fluorescence in situ hybridization detected fusion signals indicative of t(11;14)(q13;q32). In a literature review we identified only three cases of MCL with palatine involvement to date.