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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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Oral and oropharyngeal diffuse large B-cell lymphoma and high-grade B-cell lymphoma: A clinicopathologic and prognostic study of 69 cases. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 131:452-462.e4. [PMID: 33610538 DOI: 10.1016/j.oooo.2020.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The objective of this study was to describe the clinicopathological, molecular, and prognostic features of oral/oropharyngeal diffuse large B-cell lymphoma (DLBCL) and high-grade B-cell lymphoma. STUDY DESIGN All cases were retrieved from 7 Brazilian institutions. Immunohistochemical reactions were performed to confirm the diagnoses and to categorize the tumors. In situ hybridization was used to detect Epstein-Barr virus (EBV) and fluorescence in situ hybridization was used to identify gene rearrangements. RESULTS Most cases involved the oral cavity (76.8%). Males and females, with a mean age of 60 years, were evenly affected. Tumors mostly presented as painful swellings. Forty cases represented germinal center B-cell type (58%). Five cases presented double-hit translocation and 3 harbored rearrangement for MYC/BCL2/BCL6. EBV was detected in 3 cases (4.3%). The 5-year overall survival was 44.4%. Female sex, presence of pain and ulcer, microscopic "starry sky pattern" and necrosis, co-expression of c-Myc/Bcl2, and translocation of MYC were associated with a lower survival in univariate analysis (P = .05, P = .01, P = .01, P = .03, P = .05, P = .006, P = .05, respectively). CONCLUSION Patients affected by oral/oropharyngeal DLBCL have a low survival rate. High-grade B-cell lymphoma (17.7%) and EBV-positive DLBCL, not otherwise specified (4.3%) account for a small number of cases.
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Oral manifestations and clinical progression of a rare double-hit B-cell lymphoma: a case report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:e38-e43. [DOI: 10.1016/j.oooo.2019.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/28/2019] [Accepted: 12/08/2019] [Indexed: 12/22/2022]
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Ren X, Cheng Y, Wu S, Zeng X, Shi X, Ling Q, Li Z, Liang Z, Wang B. Primary non-Hodgkin lymphoma of the tongue base: the clinicopathology of seven cases and evaluation of HPV and EBV status. Diagn Pathol 2020; 15:30. [PMID: 32238190 PMCID: PMC7110811 DOI: 10.1186/s13000-020-00936-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/06/2020] [Indexed: 12/28/2022] Open
Abstract
Objectives Non-Hodgkin’s lymphoma (NHL) primarily derived from the base of the tongue, is rare. Human papillomavirus (HPV) and Epstein-Barr virus (EBV) are important aetiological risk factors for tumours of the head and neck. This study describes the clinicopathological features of NHL in the tongue base and the status of HPV and EBV in these cases. Methods Seven cases were identified from the Pathological Registry Database at Peking Union Medical College Hospital (PUMCH). The study utilized immunochemistry, in situ hybridization (ISH), and gene rearrangement to confirm the disease and and performed a clinical follow up for each case. Results All 7 lymphomas were localized at the base of the tongue. Six of the cases exhibited tongue base masses with smooth surface membranes. One case presented as multiple deep ulcers. The most common histologic subtype was diffuse large B-cell lymphoma (DLBCL), which occurred in five cases. The other two cases were mantle cell lymphoma (MCL) and peripheral T cell lymphoma, not otherwise specified (PTCL, NOS). One of the DLBCL cases was positive for HPV DNA and diffusely expressed P16 protein. During the follow up period, the MCL patient and an elderly DLBCL patient died. The remaining five patients were alive through the end of follow up. Conclusions Most lymphomas of the tongue base manifest as an endogenous mass without membranous change. The most common subtype of NHLs of the tongue base is DLBCL, and the occurrence at this site may have a good prognosis. With proper therapy, even late stage tongue base lymphomas can be suppressed and remain in remission.
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Affiliation(s)
- Xinyu Ren
- Departments of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Dongdan district Shuaifuyuan 1st, 100730, Beijing, China
| | - Yin Cheng
- Departments of Pathology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Shafei Wu
- Departments of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Dongdan district Shuaifuyuan 1st, 100730, Beijing, China
| | - Xuan Zeng
- Departments of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Dongdan district Shuaifuyuan 1st, 100730, Beijing, China
| | - Xiaohua Shi
- Departments of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Dongdan district Shuaifuyuan 1st, 100730, Beijing, China
| | - Qing Ling
- Departments of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Dongdan district Shuaifuyuan 1st, 100730, Beijing, China
| | - Zongzhu Li
- Department of Biochemistry and Molecular Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Zhiyong Liang
- Departments of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Dongdan district Shuaifuyuan 1st, 100730, Beijing, China.
| | - Beverly Wang
- Department of Pathology and Otolaryngology, UC Irvine School of Medicine, UC Irvine Medical Center, Irvine, USA.
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Pedraza RM, Arboleda LPA, Sánchez-Romero C, Quiñones JAA, Tovar CDJM, Henao JR, de Almeida OP. Intraoral EBV-positive sporadic Burkitt lymphoma in an elderly patient with bilateral presentation. AUTOPSY AND CASE REPORTS 2019; 9:e2019117. [PMID: 31641659 PMCID: PMC6771441 DOI: 10.4322/acr.2019.117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 08/05/2019] [Indexed: 12/15/2022] Open
Abstract
Sporadic Burkitt lymphoma (SBL) is a variant of Burkitt lymphoma that occurs worldwide, affecting mainly children and young adults. Association with Epstein-Barr virus (EBV) can be identified in approximately 20-30% of cases. Herein we described a case of a 63-year-old male presenting intraoral bilateral mandibular swelling, subjacent to fixed dental prosthesis, with one month of duration. Incisional biopsies were performed, and after two days, the patient was hospitalized due to malaise and breathing difficulty, and died after a week when an abdominal tumor was detected. The mandibular biopsies revealed a diffuse proliferation of medium-sized monomorphic atypical lymphoid cells exhibiting numerous mitoses and areas of "starry-sky" pattern. The tumor showed immunohistochemical positivity for CD20, CD10, Bcl-6, and Ki-67 (≈ 100%); it was negative for CD3, Bcl-2, Vs38c, and MUM-1. Positivity for EBV was found by in situ hybridization. The final diagnosis was intraoral SBL positive for EBV. Clinical, morphological and molecular criteria are necessary for the correct diagnosis of aggressive B-cell neoplasms positive for EBV in elderly patients.
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Affiliation(s)
- Ricardo Martínez Pedraza
- Universidad Autónoma de Nuevo León, School of Dentistry, Department of Advance General Dental Master. Monterrey, Nuevo León, México
| | - Lady Paola Aristizabal Arboleda
- University of Campinas, Piracicaba Dental School, Department of Oral Diagnosis, Oral Pathology Section. Piracicaba, SP, Brazil
| | - Celeste Sánchez-Romero
- University of Campinas, Piracicaba Dental School, Department of Oral Diagnosis, Oral Pathology Section. Piracicaba, SP, Brazil
| | | | | | | | - Oslei Paes de Almeida
- University of Campinas, Piracicaba Dental School, Department of Oral Diagnosis, Oral Pathology Section. Piracicaba, SP, Brazil
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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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Ryan MA, Cheng T, Yoo DS, Fisher SR. Pleomorphic Mantle Cell Lymphoma of the Tongue Base Presenting With Dysphagia. CLINICAL MEDICINE INSIGHTS. EAR, NOSE AND THROAT 2019; 12:1179550619831058. [PMID: 30828251 PMCID: PMC6390209 DOI: 10.1177/1179550619831058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 01/15/2019] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Marisa A Ryan
- Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University, Durham, NC, USA.,Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Tracy Cheng
- School of Medicine, Duke University, Durham, NC, USA
| | - David S Yoo
- Department of Radiation Oncology, Duke University, Durham, NC, USA
| | - Samuel R Fisher
- Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University, Durham, NC, USA
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Janardhanan M, Suresh R, Savithri V, Veeraraghavan R. Extranodal diffuse large B cell lymphoma of maxillary sinus presenting as a palatal ulcer. BMJ Case Rep 2019; 12:bcr-2018-228605. [PMID: 30739092 PMCID: PMC6441260 DOI: 10.1136/bcr-2018-228605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2018] [Indexed: 01/16/2023] Open
Abstract
A multitude of disease processes ranging from periodontitis to malignancies can lead to formation of solitary ulcer on the palate. Hence solitary ulcers of palate can often be a challenging one to diagnose. We report an interesting case of a diffuse large B cell lymphoma of the maxillary sinus which perforated the palatal bone and presented clinically as a palatal ulcer. Initially the lesion manifested as a small ill-defined swelling in the posterior palatal slope in relation to 24and25 which were mobile and hence was erroneously diagnosed as chronic periodontal abscess. This paper is intended to stress the relevance of including non-Hodgkin's lymphoma in the differential diagnosis of solitary palatal ulcers as it may be often misdiagnosed as more common reactive or inflammatory lesions.
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Affiliation(s)
- Mahija Janardhanan
- Department of Oral Pathology and Microbiology, Amrita School of Dentistry, AIMS Campus, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Rakesh Suresh
- Department of Oral Pathology and Microbiology, Amrita School of Dentistry, AIMS Campus, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Vindhya Savithri
- Department of Oral Pathology and Microbiology, Amrita School of Dentistry, AIMS Campus, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Ravi Veeraraghavan
- Department of Oral Surgery, Amrita School of Dentistry, AIMS Campus, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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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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Silva TDB, Ferreira CBT, Leite GB, de Menezes Pontes JR, Antunes HS. Oral manifestations of lymphoma: a systematic review. Ecancermedicalscience 2016; 10:665. [PMID: 27594910 PMCID: PMC4990057 DOI: 10.3332/ecancer.2016.665] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Indexed: 01/25/2023] Open
Abstract
Lymphoma is a malignant disease with two forms: Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL). Non-Hodgkin's lymphoma is diagnosed in extranodal sites in 40% of cases, and the head and neck region is the second most affected, with an incidence of 11-33%, while HL has a very low incidence in extranodal sites (1-4%). The aim of this study was to identify the oral manifestations of lymphoma through a systematic literature review, which we conducted using the PubMed, Lilacs, Embase, and Cochrane Library databases. We found 1456 articles, from which we selected 73. Among the intraoral findings, the most frequent were ulcerations, pain, swelling, and tooth mobility, while the extraoral findings included facial asymmetry and cervical, submandibular, and submental lymphadenopathy. Among the few studies reporting imaging findings, the most cited lesions included hypodense lesions with diffuse boundaries, bone resorptions, and tooth displacements. The publications reviewed highlight gaps in the areas of early detection, diagnosis, and proper treatment.
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Affiliation(s)
| | | | | | | | - Héliton S Antunes
- Clinical Research Division, Instituto Nacional de Câncer (INCA), Rua André Cavalcante, n 37, 2 andar, Rio de Janeiro, RJ CEP20231-050, Brazil
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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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