Benign lymphoid hyperplasia of the palate

Follicular lymphoid hyperplasia of the posterior maxillary site presenting as uncommon entity: a case report and review of the literature

BACKGROUND

Follicular lymphoid hyperplasia (FLH) is characterized by an increased number and size of lymphoid follicles. In some cases, the etiology of FLH is unclear. FLH in the oral and maxillofacial region is an uncommon benign entity which may resemble malignant lymphoma clinically and histologically.

CASE PRESENTATION

We report the case of a 51-year-old woman who presented with an asymptomatic firm mass in the left posterior maxillary site. Computed tomography scan of her head and neck showed a clear circumscribed solid mass measuring 28 × 23 mm in size. There was no evidence of bone involvement. Incisional biopsy demonstrated benign lymphoid tissue. The patient underwent complete surgical resection. Histologically, the resected specimen showed scattered lymphoid follicles with germinal centers and predominant small lymphocytes in the interfollicular areas. Immunohistochemically, the lymphoid follicles were positive for CD20, CD79a, CD10, CD21, and Bcl6. The germinal centers were negative for Bcl2. Based on these findings, a diagnosis of benign FLH was made. There was no recurrence at 1 year postoperatively.

CONCLUSIONS

We diagnosed an extremely rare case of FLH arising from an unusual site and whose onset of entity is unknown. Careful clinical and histopathological evaluations are essential in making a differential diagnosis from a neoplastic lymphoid proliferation with a nodular growth pattern.

Florid follicular lymphoid hyperplasia of the hard palatal mucosa managed with intralesional steroids: a case report and review of the literature

Follicular lymphoid hyperplasia of the palate is a benign lymphoproliferative lesion of unknown pathogenesis. It presents usually in female patients as a painless, firm, well-demarcated, usually nonulcerated, slow-growing lesion on the palate that histopathologically may resemble a lymphoma. The authors describe a patient with this condition that was successfully treated with intralesional steroid injections. Previously reported cases were reviewed to assess the results of various treatment modalities and disease-free outcome. A nonsurgical approach to the management of follicular lymphoid hyperplasia may have better patient acceptance and satisfaction without recurrence.

Submucoal lymphoid aggregates of the lower lip in a 10-year-old boy

We report an unusual case of lymphoid hyperplasia that looked like a mucocele in the lower lip of a 10-year-old boy.

Follicular lymphoid hyperplasia of the palate: report of a case and review of the literature

The follicular lymphoid hyperplasia of the palate is a very rare benign lymphoproliferative lesion that closely resembles lymphomas, clinically or histopathologically or both. A case of follicular lymphoid hyperplasia of the palate is reported. Clinically, the lesion presented as a firm, painless, nonulcerated, nonfluctuant and slowly growing swelling on one side of the palate. The biopsy showed the typical histologic features: multiple germinal centers with a rim of well-differentiated B lymphocytes together with a mixed, mainly mononuclear infiltrate with many plasmacytoid lymphocytes. The clinicopathologic features are described and integrated into a review of the 19 previously recorded cases. The diagnosis of a follicular lymphoid hyperplasia should always be considered in cases of palatal swelling.

Follicular lymphoid hyperplasia of the hard palate and oral mucosa: report of three cases and a review of the literature

AIMS

To bring to wider attention this uncommon, poorly understood entity which may closely resemble, clinically and morphologically, follicular lymphoma.

METHODS AND RESULTS

We report three cases of follicular lymphoid hyperplasia of the hard palate and oral mucosa which caused diagnostic difficulties for the referring pathologists. The clinicopathological features are described and integrated into a review of the 16 previously recorded cases. The condition most commonly presents as a slowly growing mass situated in the posterior hard palate but may present with multicentric oral lesions and lymphadenopathy. Morphologically, it is characterized by a dense follicular lymphoid infiltrate within the lamina propria which may show the classical features of benign reactive hyperplasia, but not uncommonly, indistinct germinal centres, ill-defined mantles and a lack of tingible-body macrophages are features which may lead to an erroneous diagnosis of follicular lymphoma.

CONCLUSIONS

Follicular lymphoid hyperplasia of the palate is a poorly recognized entity which is frequently confused with follicular lymphoma. Awareness of the entity combined with the use of immunohistochemistry for immunoglobulin light chains and bcl-2 protein allows a correct diagnosis to be made avoiding extensive investigation and aggressive treatment to the patient.

Immunohistochemistry of 'tertiary lymphoid follicles' in oral amalgam-associated lichenoid lesions

OBJECTIVES

To characterise lymphoid follicle-like aggregates incidentally found to occur in biopsies of oral lichenoid reactions (OLR) and to correlate the findings to hyperplastic tonsil follicles.

DESIGN

An immunocytochemical analysis of archival material.

SUBJECTS AND METHODS

In an arbitrarily selected period 1992-1994 with a total of 13,924 oral biopsies, 2407 cases were signed out as OLR or lichen planus. These were microscopically reviewed, with the purpose to retrieve all cases showing histologic changes resembling secondary lymphoid follicles.

RESULTS

87 cases showed lymphoid follicle-like changes and 82 of these were in oral regions known to constitutively lack 'organised MALT'. Unexpectedly, all of the 82 were found retrospectively to be in close or direct contact with amalgam fillings. Immunocytochemically, using antibodies to B and T cells, macrophages, follicular dendritic cells and proliferation and apoptosis markers, the mucosal follicles stained similar to tonsillar secondary follicles. In several of an additional 11 OLR cases with histologic changes suggestive of primary follicles, we also found immunocytochemical evidence of such changes.

CONCLUSIONS

'Tertiary lymphoid follicles' may occasionally develop in OLR at sites of the oral mucosa constitutively lacking organised lymphoid tissue. The microenvironment of the OLR T cell infiltrate may occasionally favour such follicle development and amalgam constituents may causally be involved in an unknown way.

Follicular lymphoid hyperplasia of the hard palate: report of a case

A review of the literature and a case report of follicular lymphoid hyperplasia (FLH) of the hard palate has been presented. This entity should always be considered when confronted with a hard-palate swelling. A diagnosis of FLH generally can be made after a thorough medical and dental examination and immunocytochemical studies of the surgical specimen. Local wide excision of the tumor is suggested as the treatment of choice. During the healing period, the use of a surgical stent will give the patient comfort as the wound heals by secondary intention.

Benign lymphoid hyperplasia of the palate: report of two cases and immunohistochemical profile

Two cases of benign lymphoid hyperplasia (BLH) of the palate are reported. The histologic appearances are those of a benign or reactive lymphoid aggregate and correlate well with other published accounts of this lesion. Using a battery of antileukocyte antibodies suitable for formalin-fixed tissue, analysis of the antigenic profile of oral BLH has been performed. The results indicate its benign nature: the germinal centres show tingible-body macrophages and polyclonal light chain restriction, the mantle zones are composed of both mature and immature B-cells, and the extramantle zones contain both B- and T-lymphocytes, plasma cells, macrophages, polymorphonuclear leukocytes and eosinophils. The histologic and immunohistochemical features are those of benign rather than malignant proliferation of lymphocytes. This is in agreement with published accounts of long-term follow-up, which have found no correlation between BLH in the mouth with either malignant association or malignant transformation.

Atypical lymphohistiocytic infiltrate (pseudolymphoma) of the oral cavity

In the oral cavity, differentiation between reactive and neoplastic lymphoproliferative lesions can, at times, be very difficult. We report an unusual case in which immunohistochemical findings were necessary to determine that the lesion was reactive despite the original interpretation of malignant lymphoma. The relationship of this lesion to atypical histiocytic granuloma, angiolymphoid hyperplasia with eosinophilia, and traumatic ulcerative granuloma with stromal eosinophilia is discussed and possible pathogenetic mechanisms are proposed. The value of immunohistochemistry in the diagnosis of extranodal lymphoproliferative lesions is emphasized.