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Bhakta P, Youssef A, Bigham L, Mallick J, Bhargava P, Rawas F, Weaver D, Hunzeker ZE, Dong J, Willis M, Qiu S, Nawgiri R, Iguh CCC, Lyapichev KA. Proposal of Diagnostic Approach of Periodontal Primary Non Hodgkin Lymphoma of Bone with Flow Cytometry as an Essential Diagnostic Component. Head Neck Pathol 2022; 16:1091-1102. [PMID: 35802244 PMCID: PMC9729681 DOI: 10.1007/s12105-022-01469-y] [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: 04/03/2022] [Accepted: 06/16/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Primary bone lymphoma is a rare type of lymphoid neoplasm with favorable prognosis, where Primary Non Hodgkin Lymphoma of bone (PB-NHL) is most common with the subtype. Amongst PB-NHL, diffuse large Bcell lymphoma represents the majority of cases. The mandible is a very uncommon site of involvement, presenting as a painful bone mass with high suspicion of osteomyelitis. METHODS We report the case of a 45-year-old male with no significant past medical history who was admitted to the hospital with a large right jaw mass and pain after recent tooth removal. The original tissue biopsy was not diagnostic, and cultures were found to be negative for microorganisms. Due to enlargement of the mass, a fine needle aspiration (FNA) was done. At the time of rapid onsite evaluation of the FNA, atypical lymphoid cells were seen, and material was obtained for flow cytometry (FC) evaluation. This revealed an aberrant clonal B-cell population. The consequent immunohistochemical evaluation of original material supported the diagnosis of PB-NHL. After chemotherapy patient improved. RESULTS After an extensive English language literature review, we identified and summarized the clinical presentations, diagnostic procedures, histopathologic features, treatment methods, and outcomes of forty-two cases of periodontal PB-NHL. Based on our findings, we propose a set of clinical features at initial presentation to increase the clinical suspicion of periodontal PB-NHL for practitioners. CONCLUSION Based on our institution's experience and the literature review conclusions, we propose the University of Texas Medical Branch diagnostic approach for PB-NHL and suggest that FNA and FC should be utilized as the essential diagnostic component. The fast and efficient diagnosis of PB-NHL can facilitate the correct treatment and sufficiently improve patient care.
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Affiliation(s)
- Pooja Bhakta
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX USA
| | - Ayman Youssef
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX USA
| | - Lindsay Bigham
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX 77555 USA
| | - Jayati Mallick
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX 77555 USA
| | - Peeyush Bhargava
- Department of Radiology, University of Texas Medical Branch, Galveston, TX USA
| | - Faisal Rawas
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX 77555 USA
| | - Dylan Weaver
- Department of Radiology, University of Texas Medical Branch, Galveston, TX USA
| | - Zachary E. Hunzeker
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX USA
| | - Jianli Dong
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX 77555 USA
| | - Maurice Willis
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX USA
| | - Suimin Qiu
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX 77555 USA
| | - Ranjana Nawgiri
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX 77555 USA
| | | | - Kirill A. Lyapichev
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX 77555 USA
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Hassona Y, Saleh MW, Alkhawaldeh H, Al Abweh R. Unusual cause of tooth mobility. BMJ Case Rep 2020; 13:13/12/e235086. [PMID: 33370928 DOI: 10.1136/bcr-2020-235086] [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: 11/04/2022] Open
Abstract
We describe a case of a 71-year-old otherwise healthy man who presented to the dental clinic with the chief complaint of mobility involving his upper left molar teeth. The patient was a febrile, and clinical oral examination revealed localised grade II mobility and absence of gingival swelling, erythema or sinus tract. Orthopantogram revealed a poorly defined radiolucency involving the upper left second and third molar teeth. Surgical exploration of the involved area was performed and revealed the presence of a 'jelly like' brown tissue that fragments easily. Pathological examination confirmed the diagnosis of diffuse large B cell lymphoma.
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Affiliation(s)
- Yazan Hassona
- Faculty of Dentistry, University of Jorddan, Amman, Jordan
| | | | | | - Ruba Al Abweh
- Faculty of Dentistry, University of Jorddan, Amman, Jordan
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3
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Sundaresan PD, Foo M. Incidental finding of monoclonal B-cell lymphocytosis in the mandible. BMJ Case Rep 2020; 13:13/9/e232339. [PMID: 32878848 DOI: 10.1136/bcr-2019-232339] [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: 11/04/2022] Open
Abstract
A 78-year-old man was referred to the Special Needs Dentistry Clinic for review prior to beginning bisphosphonate treatment as part of the management for his metastatic prostate cancer given the increased risk of medication-related osteonecrosis of the jaws in this patient cohort. Imaging revealed a well-defined radiolucency in the mandible that was closely associated with a non-vital anterior tooth. The lesion was asymptomatic. Incisional biopsy revealed a low grade B cell lymphoproliferation compatible with a monoclonal B-cell lymphocytosis (MBL). The patient was subsequently referred to haematology as MBL may develop into chronic lymphocytic leukaemia.
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Affiliation(s)
- Pritam Daniel Sundaresan
- Maxillofacial & Dental Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia .,Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Magdalen Foo
- Maxillofacial & Dental Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia.,Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
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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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5
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Mortazavi H, Baharvan M, Rezaeifar K. Periapical lymphoma: Review of reported cases in the literature. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 121:404-407. [PMID: 32035143 DOI: 10.1016/j.jormas.2020.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/29/2020] [Accepted: 01/31/2020] [Indexed: 11/25/2022]
Abstract
Oral lymphoma can resemble clinically to other pathologic entities such as periapical radiolucencies, or dental abscess. The aim of this study was to review the literature related to misdiagnosed periapical lymphomas and discuss their characteristics. In this review study, authenticated search engines and databases such as Google Scholar, PubMed, PubMed Central, Science Direct, and Scopus were surfed to find articles related to the topic by using related keywords. Out of more than 100 articles approximately, 50 were closely relevant to the title, and ultimately 43 well-documented English articles were chosen. Out of 45 reported cases, 63% were male and 37% were female with mean age of 41.22 years. The majority of such lesions have been detected in the mandible (61%) with a mandibular to maxillary involvement ratio of 1.58:1. The most frequent type of lymphoma was diffuse large B cell lymphoma (DLBCL) (53%). Noteworthy, 49% of periapical lymphoma has been misdiagnosed as pulpal pathology and treated through root canal therapy. The mean time lapse before making the correct diagnosis was 4.3 months. Although rare, periapical lymphoma should be ranked in the differential diagnosis of a periapical lesion especially when vitality pulp tests are positive.
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Affiliation(s)
- H Mortazavi
- Department of Oral Medicine, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - M Baharvan
- Department of Oral Medicine, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - K Rezaeifar
- Department of Oral Medicine, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Batta N, Shukla M, Pandey M. Natural course of diffuse large B cell lymphoma-a manifestation in buccal mucosa. World J Surg Oncol 2019; 17:219. [PMID: 31842892 PMCID: PMC6916459 DOI: 10.1186/s12957-019-1766-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 12/02/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transformation and progression of lymphoma after treatment is well known; however, since the advent of chemotherapy and radiotherapy, progression in untreated lymphoma is seldom seen. We present a case which was misdiagnosed and treated as abdominal tuberculosis later presented with progression and involvement of oral cavity. CASE PRESENTATION A 41-year-old male who presented with urinary symptoms and abdominal pain was diagnosed as abdominal tuberculosis and treated. Two years later, he presented with B symptoms and oral cavity lesion that was diagnosed as diffuse large B cell lymphoma. The patient was treated with R-CHOP chemotherapy with complete regression of the lesion. CONCLUSION Involvement of extranodal sites in predominantly nodal disease does occur; however, involvement of oral cavity is rare. Though primary extranodal lymphoma is reported to occur in oral cavity and oropharynx, natural progression in untreated disease is seldom documented.
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Affiliation(s)
- Nishant Batta
- Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India.,SRL Diagnostics, Lanka, Varanasi, India
| | - Mridula Shukla
- Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India.,SRL Diagnostics, Lanka, Varanasi, India
| | - Manoj Pandey
- Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India. .,SRL Diagnostics, Lanka, Varanasi, India.
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Yucesoy T, Kilic E, Ocak H, Alkan A, Deniz K. Gastrointestinal tract metastasis of mandibular diffuse large B-cell lymphoma. Clin Case Rep 2018; 6:1713-1717. [PMID: 30214748 PMCID: PMC6132166 DOI: 10.1002/ccr3.1704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/01/2018] [Accepted: 06/07/2018] [Indexed: 12/13/2022] Open
Abstract
Not only diffuse large B-cell lymphoma is a malignancy, but also is initially and orally diagnosed in early stages. However, it could be misdiagnosed with other oral pathologies. However yet, early diagnosis is still crucial for the prognosis, morbidity, and mortality in such cases. Additionally, whole-body scanning with positron emission tomography/computed tomography should be performed for diagnosis and treatment process.
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Affiliation(s)
- Turker Yucesoy
- Faculty of DentistryDepartment of Oral and Maxillofacial SurgeryBezmialem Vakif UniversityIstanbulTurkey
| | - Erdem Kilic
- Faculty of DentistryDepartment of Oral and Maxillofacial SurgeryBezmialem Vakif UniversityIstanbulTurkey
| | - Hakan Ocak
- Department of Oral and Maxillofacial SurgeryPrivate ClinicKayseriTurkey
| | - Alper Alkan
- Faculty of DentistryDepartment of Oral and Maxillofacial SurgeryBezmialem Vakif UniversityIstanbulTurkey
| | - Kemal Deniz
- Department of Pathology, Medicine FacultyErciyes UniversityKayseriTurkey
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8
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Silva RNF, Mendonça EF, Batista AC, Alencar RDCG, Mesquita RA, Costa NL. T-Cell/Histiocyte-Rich Large B-Cell Lymphoma: Report of the First Case in the Mandible. Head Neck Pathol 2018; 13:711-717. [PMID: 30019325 PMCID: PMC6854205 DOI: 10.1007/s12105-018-0948-9] [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] [Received: 05/04/2018] [Accepted: 07/12/2018] [Indexed: 12/29/2022]
Abstract
T-cell/histiocyte-rich large B-cell lymphoma (THRBCL) is an uncommon subtype of non-Hodgkin's lymphoma. It is a predominant nodal neoplasm; however, extranodal sites, such as the spleen, liver and bone marrow, can be involved at diagnosis. However, only one case of primary THRLBCL in the jaws have been reported. We herein describe a 29-year-old female patient who presented with a swelling of the right mandible that had grown rapidly over the previous 2 months. Periapical and panoramic radiographs showed a multilocular osteolytic lesion located in the mandibular periapical region of the canine and premolar teeth and molar region. Preoperative examination and incisional biopsy were performed. Immunohistochemistry was applied to confirm the diagnosis of THRBCL in the jaw. The treatment consisted of CHOP therapy and radiotherapy. After complete tumor remission following initial treatment, additional sites of the disease appeared in the lung, abdomen and long bones. The patient died within 2 months. THRLBCL is an uncommon and aggressive malignant neoplasm that can involve the jaws, mimicking a periapical disease.
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Affiliation(s)
- Ricardo Natã Fonseca Silva
- Department of Stomathology (Oral Pathology), School of Dentistry, Federal University of Goias, Goiânia, GO Brazil
| | - Elismauro Francisco Mendonça
- Department of Stomathology (Oral Pathology), School of Dentistry, Federal University of Goias, Goiânia, GO Brazil ,Division of Head and Neck, Araújo Jorge Hospital, Association of Cancer Combat of Goiás, Goiânia, Brazil
| | - Aline Carvalho Batista
- Department of Stomathology (Oral Pathology), School of Dentistry, Federal University of Goias, Goiânia, GO Brazil
| | | | - Ricardo Alves Mesquita
- Department of Oral Surgery and Pathology, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG Brazil
| | - Nadia Lago Costa
- Department of Stomathology (Oral Pathology), School of Dentistry, Federal University of Goias, Goiânia, GO Brazil
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9
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Radiographic Enlargement of Mandibular Canal as an Extranodal Primary Non-Hodgkin's Lymphoma Early Sign in an Asymptomatic Patient. Case Rep Dent 2017; 2017:9193165. [PMID: 28299210 PMCID: PMC5337308 DOI: 10.1155/2017/9193165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 01/31/2017] [Indexed: 01/01/2023] Open
Abstract
Non-Hodgkin's lymphoma (NHL) is a lymphoproliferative disorder, from a subgroup of heterogeneous hematologic malignancies; the term “extranodal” refers to malignant involvement of tissues other than lymph nodes, tonsils, spleen, pharyngeal lymphatic ring, or thymus. Only 0.6% of all NHL are at mandible alone, and it may involve the inferior alveolar canal. We describe a case of bilateral enlargement of the mandibular canal without symptomatology, which was shown in a panoramic radiograph and cone beam computed tomography in a rehabilitation routine exam, as an early sign of primary extranodal NHL.
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10
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Intraosseous Non-Hodgkin Lymphoma Mimicking a Periapical Lesion. J Endod 2015; 41:1738-42. [DOI: 10.1016/j.joen.2015.06.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 06/03/2015] [Accepted: 06/04/2015] [Indexed: 12/17/2022]
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11
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Kumar G, Hingad N, Singh N, Sidhu GK. Diffuse large B - Cell lymphoma involving the maxilla in a minor. J Clin Diagn Res 2015; 8:ZD26-8. [PMID: 25654050 DOI: 10.7860/jcdr/2014/11446.5350] [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: 09/26/2014] [Accepted: 11/03/2014] [Indexed: 11/24/2022]
Abstract
Lymphomas can be simply defined as malignant neoplasms of lymphocytes and their precursor cells. We report a case of a diffuse large B-cell lymphoma of the maxilla, in an 11-year-old male patient who reported with a diffuse swelling of the maxillary labial mucosa accompanied with oral candidiasis. A subsequent biopsy and immunohistochemistry were instrumental in this diagnosis. What makes this case significant is that the incidence of primary DLBCL in the oral cavity of a minor which is not very common and has rarely been specified earlier in the literature.
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Affiliation(s)
- Garish Kumar
- Reader, Department of Oral Pathology and Microbiology, Maharaja Ganga Singh Dental College and Research Center Sriganganagar, Rajasthan, India
| | - Nupur Hingad
- Reader, Department of Oral Pathology and Microbiology, Sri Sukhmani Dental College and Hospital , Dera Bassi, Punjab, India
| | - Navneet Singh
- Senior Lecturer, Department of Oral Pathology and Microbiology, Maharaja Ganga Singh Dental College and Research Center Sriganganagar, Rajasthan, India
| | - Gagandeep Kaur Sidhu
- Senior Lecturer, Department of Oral Pathology and Microbiology, Maharaja Ganga Singh Dental College and Research Center Sriganganagar, Rajasthan, India
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12
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Mochizuki Y, Harada H, Sakamoto K, Kayamori K, Nakamura S, Ikuta M, Kabasawa Y, Marukawa E, Shimamoto H, Tushima F, Omura K. Malignant Lymphoma with Initial Symptoms in the Mandibular Region. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/jct.2015.67060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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13
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Diffuse large B-cell lymphoma of the mandible with periosteal reaction: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117:e228-32. [PMID: 24439924 DOI: 10.1016/j.oooo.2013.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 11/15/2013] [Accepted: 12/03/2013] [Indexed: 12/20/2022]
Abstract
This report describes a rare case of a 63-year-old man with a lymphoma in the right mandibular ramus with periosteal reaction. Computed tomography (CT) images showed a soft tissue density (28 × 48 × 32 mm) around the right mandibular foramen. Bone-mode CT images showed diffuse bone destruction of the right mandibular ramus. Moreover, a periosteal reaction was seen on the lingual cortical bone of the right mandibular ramus. Histopathologic examination found a diffuse large B-cell lymphoma.
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14
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Nayak PB, Desai D, Pandit S, Rai N. Centroblastic variant of diffuse large B-cell lymphoma: Case report and review of literature. J Oral Maxillofac Pathol 2013; 17:261-5. [PMID: 24250090 PMCID: PMC3830238 DOI: 10.4103/0973-029x.119749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is a subtype of non-Hodgkin's lymphoma (NHL) making up about approximately 30% of all NHL. Its occurrence in the mandible is very rare. Histopathologically, five variants of DLBCL have been recognized among which centroblastic variant is the one with better prognosis. We report a case of a 55 year-old patient who presented with a painless swelling in the lower right body of the mandible since 4 months. Incisional biopsy revealed NHL like features, confirmed by immunohistochemistry using CD45, CD20, and CD3 markers to be a DLBCL of centroblastic variant. Patient was treated with chemotherapy following which the lesion regressed completely with no further recurrences. Precise histological diagnosis is crucial for the clinical management and ultimately for the survival of the patient.
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Affiliation(s)
- Preethi B Nayak
- Department of Oral Pathology and Microbiology, A. J. Institute of Dental Sciences, Kuntikana, Mangalore, Karnataka, India
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15
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Meltzer DE, Shatzkes DR. Masticator space: imaging anatomy for diagnosis. Otolaryngol Clin North Am 2013; 45:1233-51. [PMID: 23153747 DOI: 10.1016/j.otc.2012.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Masticator space anatomy and pathologic conditions are illustrated examples from computed tomography and magnetic resonance imaging. Characteristic imaging features of various disease processes are presented to aid the otolaryngologist (head and neck surgeon) in diagnosis. The article describes infection, primary neoplasm, metastatic disease, Osteonecrosis, and vascular anomalies.
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Affiliation(s)
- Daniel E Meltzer
- Department of Radiology, Albert Einstein College of Medicine, St. Luke's-Roosevelt Hospital Center, New York, NY, USA.
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16
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Unilateral widening of the inferior alveolar nerve canal: a rare anatomic variant mimicking disease. Oral Radiol 2012. [DOI: 10.1007/s11282-012-0118-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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17
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Primary maxillofacial large B-cell lymphoma in immunocompetent patients: report of 5 cases. Case Rep Radiol 2011; 2011:108023. [PMID: 22606537 PMCID: PMC3350266 DOI: 10.1155/2011/108023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 07/03/2011] [Indexed: 02/07/2023] Open
Abstract
Lymphomas of the oral cavity represent 5% of all lymphomas. They usually occur in immunocompromised patients. Lymphoma arising within a single bone, without visceral or lymph node involvement, is known as primary intraosseous lymphoma. It is a rare condition and constitutes 3.1% of malignant bone tumors and 5% of extranodal lymphomas. Primary lymphoma of the jaw is seldom seen and it is often misdiagnosed. Clinically, the manifestations are usually similar to an odontogenic tumor, cyst, or infection. Radiographically it appears as a radiolucent area that may mimic endodontic lesion, periodontal pathology, or odontogenic cyst or tumor. The initial presentation is commonly followed by multiple unnecessary extractions and/or root canal treatments. We present five cases of rare primary lymphoma of the maxillofacial complex, four of them intraosseous.
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18
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Buric N, Jovanovic G, Radovanovic Z, Buric M, Tijanic M. Radiographic enlargement of mandibular canal as first feature of non-Hodgkin's lymphoma. Dentomaxillofac Radiol 2011; 39:383-8. [PMID: 20729189 DOI: 10.1259/dmfr/16059055] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Non-Hodgkin's lymphoma has the propensity to affect non-lymphoid tissue including oral tissue. Primary non-Hodgkin's lymphoma of the mandible mistreated as chronic periodontitis with diffuse enlargement of the mandibular canal and ice-cold numbness is very rarely described in English medical literature. A 57-year-old patient presented with a painful swelling on the left side of the mandible with a clinically chronic periodontitis associated with ice-cold numbness. A panoramic radiograph showed a diffuse uniform enlargement of the mandibular canal. Histological examination showed that the lesion was a primary intraosseous non-Hodgkin's lymphoma of the mandible. Immunohistochemical examination showed a positive reaction for CD20+, Ki-67+. Seven months after chemotherapy the patient was observed for possible life-threatening propagation of the disease. In conclusion, primary (extra-nodal) non-Hodgkin's lymphoma of the mandible usually clinically presents with bone swelling, teeth mobility and neurological disturbance. Radiographic features presenting as diffuse enlargement of the mandibular canal could be considered as non-Hodgkin's lymphoma.
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Affiliation(s)
- N Buric
- Department of Oral and Maxillofacial Surgery, University of Nis School of Medicine and Stomatology, Serbia.
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Abstract
Primary non-Hodgkins's lymphoma is a very uncommon lesion, accounting for 0.6% in jaws. As the lesions frequently resemble other disease such as chronic osteomyelitis, odontogenic or any secondary neoplasms, further evaluation and histopathologic examination allow early identification for appropriate treatment. The purpose of this case report is to describe a rare case of non-Hodgkin's lymphoma of the mandible, explore the diagnosis and workup based on immunohistochemistry.
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Affiliation(s)
- J Dinakar
- Department of Oral Pathology, Sri Ramakrishna Dental College and Hospital, Coimbatore, India
| | - Lakshmi Priya
- Department of Oral Pathology, Sri Ramakrishna Dental College and Hospital, Coimbatore, India
| | - Samyukta Reddy
- Department of Oral Pathology, Sri Ramakrishna Dental College and Hospital, Coimbatore, India
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20
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Saund D, Kotecha S, Rout J, Dietrich T. Non-resolving periapical inflammation: a malignant deception. Int Endod J 2010; 43:84-90. [DOI: 10.1111/j.1365-2591.2009.01644.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Abstract
With advancements in diagnosis and treatment for lymphoma, it is important that physicians be up to date in the management of these lymphoproliferative disorders, their associated complications, and the complications of treatment. The importance of a thorough examination of the oro-facial complex and neck on all patients cannot be overemphasized. Oral and maxillofacial surgeons continue to make significant contributions in what has become a multidisciplinary approach to managing lymphoproliferative disease.
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Affiliation(s)
- Aaron Liddell
- Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
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Djavanmardi L, Oprean N, Alantar A, Bousetta K, Princ G. Malignant non-Hodgkin's lymphoma (NHL) of the jaws: a review of 16 cases. J Craniomaxillofac Surg 2008; 36:410-4. [PMID: 18562205 DOI: 10.1016/j.jcms.2008.03.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Accepted: 12/28/2007] [Indexed: 12/15/2022] Open
Abstract
Non-Hodgkin's lymphoma (NHL) is rarely found in the jaw. We present 16 cases and the purpose of this study was to analyze the clinical signs and symptoms. The treatment and the progression evolution are also mentioned. The diagnosis was usually difficult and was often misleading and so delays before the first bone biopsy were frequent. The therapy of this rare, diffuse, large cell lymphoma was very variable from one case to another but the majority of the patients were treated with a combination of chemotherapy and radiotherapy.
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23
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Adouani A, Bouguila J, Jeblaoui Y, Ben Aicha M, Abdelali MA, Hellali M, Zitouni K, Amani L, Issam Z. B-cell lymphoma of the mandible: a case report. Clin Med Oncol 2008; 2:445-50. [PMID: 21892315 PMCID: PMC3161690 DOI: 10.4137/cmo.s366] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Introduction The mandible is an infrequent localisation of primary osseous non-Hodgkin’s lymphomas. Few cases of mandibular non-Hodgkin’s lymphomas (NHL) have been reported. Case report A rare condition of primary malignant non-Hodgkin’s lymphoma of the mandible in 53-year-old man, was reported at the Department of Maxillofacial and Plastic Surgery in Charles Nicolle Hospital (Tunis, Tunisia). Histologic and Immunohistochemical (IHC) examination Confirmed a B-Cell lymphoma. Discussion The purpose of this report is to describe this rare case of NHL of the mandible, explore the diagnosis and workup, and discuss treatment strategies. In this localisation, neither the clinical features nor the radiologic appearances are often pathognomonic. Conclusion Particular care must be taken to consider lymphoma in the differential diagnosis because this uncommon lesion can pose significant diagnostic problems and is frequently misdiagnosed.
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Affiliation(s)
- Ali Adouani
- Departement of Maxillofacial and Plastic Surgery. Charles Nicolle Hospital. Tunis-Tunisia (Head of the department: Ali Adouani)
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24
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Ishimaru T, Hayatsu Y, Ueyama Y, Shinozaki F. Hodgkins lymphoma of the mandibular condyle: report of a case. J Oral Maxillofac Surg 2005; 63:144-7. [PMID: 15635570 DOI: 10.1016/j.joms.2004.06.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Takanori Ishimaru
- Department of Oral and Maxillofacial Surgery, National Hospital Organization, Kanmon Medical Center, Yamaguchi, Japan.
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25
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Longo F, De Maria G, Esposito P, Califano L. Primary non-Hodgkin's lymphoma of the mandible. Report of a case. Int J Oral Maxillofac Surg 2005; 33:801-3. [PMID: 15556331 DOI: 10.1016/j.ijom.2003.12.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2003] [Indexed: 12/18/2022]
Abstract
A case of a 45-year-old white man admitted for an osteomyelitis and subsequently diagnosed affected by an IE stage, diffuse high grade large B cell non-Hodgkin's lymphoma of the mandible is reported. The patient presented a swelling in the right mandibular region with paraesthesia of the ipsilateral lower lip without nodal involvement of the neck. After an incisional biopsy, which showed a diffuse high grade large B-cell non-Hodgkin's lymphoma, the patient was staged and treated with CEOP protocol for six courses and subsequently external beam radiation therapy with complete remission of the lesion.
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Affiliation(s)
- F Longo
- Department of ENT Head & Neck Surgery, National Cancer Institute of Naples, Naples 80131, Italy.
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26
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Leiggener CS, Kunz C, Lohri A, Fridrich K, Honigmann K. HIV-assoziiertes Lymphom ? ungew�hnliche Ursache einer pathologischen Unterkieferfraktur. ACTA ACUST UNITED AC 2004; 9:48-52. [PMID: 15688241 DOI: 10.1007/s10006-004-0581-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Despite the introduction of highly active antiretroviral therapy (HAART), diffuse large B-cell lymphoma (DLBCL) remains a common malignancy in human immunodeficiency virus (HIV)-infected patients, especially the plasmablastic variant. About 50% of lymphomas in HIV patients are extranodal and half of them occur in the head and neck area. The main oral symptoms are pain, swelling, numbness and tooth mobility. We report the case of a 52-year-old patient with a known HIV infection and fracture of the angular region of the mandible. The fracture did not unite following open reduction and osteosynthesis. A biopsy performed at the time of revision revealed the diagnosis of a primary lymphoma in the mandible. After chemotherapy had induced complete remission of the lymphoma and autogenous iliac crest bone grafting had been performed the fracture united. Primary lymphoma in the mandible is a disease that presents with a nonspecific radiological appearance which may mimic osteomyelitis or periodontal pathology. A rapid and accurate diagnosis is critical for the appropriate treatment. In our experience HIV-positive patients with mandibular fracture should be treated according to the guidelines established for HIV-negative patients. However, risky compromises such as intraoral approach or hazardous fracture fixation should be avoided.
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MESH Headings
- Biomarkers, Tumor/analysis
- Biopsy
- Bone Transplantation
- Diagnosis, Differential
- Fracture Fixation, Internal
- Fractures, Spontaneous/diagnosis
- Fractures, Spontaneous/pathology
- Fractures, Spontaneous/surgery
- Fractures, Ununited/diagnosis
- Fractures, Ununited/pathology
- Fractures, Ununited/surgery
- Humans
- Lymphoma, AIDS-Related/diagnosis
- Lymphoma, AIDS-Related/pathology
- Lymphoma, AIDS-Related/surgery
- Male
- Mandible/pathology
- Mandible/surgery
- Mandibular Fractures/diagnosis
- Mandibular Fractures/pathology
- Mandibular Fractures/surgery
- Mandibular Neoplasms/diagnosis
- Mandibular Neoplasms/pathology
- Mandibular Neoplasms/surgery
- Middle Aged
- Postoperative Complications/diagnosis
- Postoperative Complications/pathology
- Postoperative Complications/surgery
- Reoperation
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Affiliation(s)
- C S Leiggener
- Abteilung für Kiefer- und Gesichtschirurgie, Universitätsklinik für Wiederherstellende Chirurgie, Universitätsspital, Basel, Schweiz.
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27
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Pazoki A, Jansisyanont P, Ord RA. Primary non-Hodgkin's lymphoma of the jaws: Report of 4 cases and review of the literature. J Oral Maxillofac Surg 2003; 61:112-7. [PMID: 12524617 DOI: 10.1053/joms.2003.50018] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Alexander Pazoki
- Head and Neck Oncology, Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, MD, USA
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28
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Kirita T, Ohgi K, Shimooka H, Okamoto M, Yamanaka Y, Sugimura M. Primary non-Hodgkin's lymphoma of the mandible treated with radiotherapy, chemotherapy, and autologous peripheral blood stem cell transplantation. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2000; 90:450-5. [PMID: 11027381 DOI: 10.1067/moe.2000.108441] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Extranodal presentation in non-Hodgkin's lymphoma (NHL) is uncommon, and the mandible is very rarely involved. Primary NHL of the mandible, for the most part, has intermediate or high malignancy and has a much greater incidence of local recurrence compared with other sites of involvement. A 48-year-old Japanese man with NHL of the mandible received radiotherapy, followed by high-dose chemotherapy supported with peripheral blood stem cell transplantation (PBSCT). High-dose cyclophosphamide, Adriamycin, and vincristine were used for pretransplant conditioning. He achieved complete remission and has survived in continuous complete remission for more than 72 months to date. Marrow-ablative chemotherapy facilitated by PBSCT is thought to be useful as part of the primary therapy for patients with NHL who have poorer prognoses.
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Affiliation(s)
- T Kirita
- Nara Medical University, Oral and Maxillofacial Surgery, Japan.
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29
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Yamada T, Kitagawa Y, Ogasawara T, Yamamoto S, Ishii Y, Urasaki Y. Enlargement of mandibular canal without hypesthesia caused by extranodal non-Hodgkin's lymphoma: a case report. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2000; 89:388-92. [PMID: 10710468 DOI: 10.1016/s1079-2104(00)70107-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A rare condition of enlargement of the mandibular canal caused by an extra-nodal non-Hodgkin's lymphoma in a 59-year-old Japanese woman was reported. The patient had a swelling of the hard palate and protrusion of both ocular bulbs, which had been present for 10 years. A panoramic radiograph revealed that the right mandibular canal was widely enlarged, extending from the mandibular foramen to the mental foramen, without bone destruction. The continuous dilation of the mandibular canal to an approximate 15-mm width was associated with peripheral bony sclerosis. Computed tomography and magnetic resonance imaging showed a soft tissue tumor inside the mandibular canal. The lesion demonstrated expansive growth in the orbits, extending to the skull base through the superior orbital fissures and cavernous sinus. The lymphoma was suspected to have grown so slowly that the adjacent mandibular canal and ocular bulbs enlarged without destroying the normal bone and nervous tissue.
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Affiliation(s)
- T Yamada
- Department of Dentistry and Oral Surgery and Internal Medicine, Fukui Medical University, Japan.
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30
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Porter SR. Gingival and periodontal aspects of diseases of the blood and blood-forming organs and malignancy. Periodontol 2000 1998; 18:102-10. [PMID: 10200716 DOI: 10.1111/j.1600-0757.1998.tb00142.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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31
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Piatelli A, Croce A, Tete S, Artese L. Primary non-Hodgkin's lymphoma of the mandible: a case report. J Oral Maxillofac Surg 1997; 55:1162-6. [PMID: 9331243 DOI: 10.1016/s0278-2391(97)90300-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- A Piatelli
- Oral Pathology and Medicine, Dental School, University of Chieti, Italy
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32
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Kawasaki G, Nakai M, Mizuno A, Nakamura T, Okabe H. Malignant lymphoma of the mandible: report of a case. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1997; 83:345-9. [PMID: 9084197 DOI: 10.1016/s1079-2104(97)90241-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Extranodal malignant lymphoma is relatively rare. When it occurs in the oral region, it is sometimes misdiagnosed as inflammatory disease. This report details a case of malignant lymphoma that involved the fight mandibular region.
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Affiliation(s)
- G Kawasaki
- First Department of Oral and Maxillofacial Surgery, Nagasaki University School of Dentistry, Japan
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33
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Bertolotto M, Cecchini G, Martinoli C, Perrone R, Garlaschi G. Primary lymphoma of the mandible with diffuse widening of the mandibular canal: report of a case. Eur Radiol 1996; 6:637-9. [PMID: 8934126 DOI: 10.1007/bf00187663] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A case of primary non-Hodgkin's lymphoma (NHL) of the mandible with unusual radiographic presentation is reported. The panoramic radiography revealed diffuse widening of the right mandibular canal with ill-defined margins and absence of edge sclerosis. Computed tomography showed infiltration of the superior portion of the canal with involvement of the vestibular cortex of the bone and of the alveolar ridge.
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Affiliation(s)
- M Bertolotto
- Institute of Radiology, University of Genoa, Italy
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34
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Piattelli A, Di Alberti L, Artese L. Non-Hodgkin's lymphoma of the tongue: a case report. EUROPEAN JOURNAL OF CANCER. PART B, ORAL ONCOLOGY 1996; 32B:207-9. [PMID: 8762879 DOI: 10.1016/0964-1955(95)00061-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Oral manifestations are present in about 3-5% of cases of non-Hodgkin's lymphoma (NHL) and oral lesions are only rarely the initial manifestations of NHL. A case is presented of an 80-year-old patient with a NHL of the tongue, without visceral or lymph node involvement. The diagnosis of NHL can be made only by biopsy. The prognosis of NHL seems to be related to the tumour stage, tumour aggressiveness and response to treatment: the oral lesions appear to respond quite well to irradiation.
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35
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Ríos-Martín JJ, Villar-Rodríguez JL, Vázquez-Ramírez FJ, Illanes-Moreno M, Parra-Martín JA, González-Cámpora R, Galera-Davidson H. Mandibular lymphomas with sclerosis. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1996; 81:321-7. [PMID: 8653466 DOI: 10.1016/s1079-2104(96)80332-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Two cases of non-Hodgkin's lymphoma that show a sarcomatoid pattern within the jaw are described. Their primary origin in bone was demonstrated by radiologic studies. In one case, diagnosis was delayed because the clinical picture suggested inflammatory periodontal disease. In both cases, the histologic picture was similar to that of a sarcomatoid neoplasm with intense stromal sclerosis; hemimandibulectomy was performed in one case. The tumor contained cells with large, irregular, sometimes lobulated nuclei and high mitotic activity, and perforated mandibular bone with infiltration into adjacent soft tissues. The lymphoid nature of these neoplasms was demonstrated by immunohistochemical and ultrastructural study.
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Affiliation(s)
- J J Ríos-Martín
- Department of Pathology, Hospital Universitario Virgen Macarena, Seville, Spain
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36
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Affiliation(s)
- D A Ugar
- University of Gazi, Ankara, Turkey
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37
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Abstract
Intrabony lymphoma can mimic periradicular inflammatory disease of pulpal origin. Mismanagement of such cases can result if the clinician presumes the condition is inflammatory and fails to submit a tissue specimen for evaluation. This article reviews the features of jaw lymphoma and documents the importance of early diagnosis and histopathologic examination.
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Affiliation(s)
- J M Wright
- Department of Pathology, Baylor College of Dentistry, Dallas 75246
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38
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Barber HD, Stewart JC, Baxter WD. Non-Hodgkin's lymphoma involving the inferior alveolar canal and mental foramen: report of a case. J Oral Maxillofac Surg 1992; 50:1334-6. [PMID: 1447619 DOI: 10.1016/0278-2391(92)90240-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- H D Barber
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University of Pennsylvania, Philadelphia 19104-6003
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39
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Abstract
A patient was treated for infraorbital swelling, nonvital teeth and a periapical lesion. Suspected malignancy, confirmed with an early biopsy, resulted in diagnosis of non-Hodgkin's lymphoma.
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