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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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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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Non-Hodgkin’s lymphoma: A dangerous differential for an innocent-looking lump. Oral Oncol 2020; 108:104953. [DOI: 10.1016/j.oraloncology.2020.104953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 07/30/2020] [Indexed: 12/26/2022]
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4
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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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Kamat M, Datar U, Kanitkar S, Byakodi S. Intraoral HIV-associated Burkitt's lymphoma: a rare case report with special emphasis on differential diagnosis. J Korean Assoc Oral Maxillofac Surg 2019; 45:225-229. [PMID: 31508356 PMCID: PMC6728624 DOI: 10.5125/jkaoms.2019.45.4.225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 03/16/2018] [Accepted: 03/22/2018] [Indexed: 12/02/2022] Open
Abstract
Individuals with human immunodeficiency virus (HIV) infection present with unique intraoral manifestations of various neoplasms. Intraoral HIV-associated Burkitt's lymphoma is a rare presentation, especially in patients of Indian origin and may present as an initial sign of HIV. The objective of this paper is to report a rare case of Burkitt's lymphoma in an HIV-positive Indian patient along with a special emphasis on differential diagnosis. A 30-year-old Indian female presented with a solitary, well-defined, exophytic mass extending anteroposteriorly and buccolingually from the 35th to 38th regions with no evidence of intraosseous extension. An incisional biopsy was performed, and histopathology showed sheets of neoplastic lymphoid cells with numerous tingible body macrophages with clear cytoplasm, presenting a starry sky appearance, suggesting a diagnosis of BL. The tumor cells were positive for CD10, CD20, c-myc, and Epstein-Barr virus, with a nearly 100% Ki-67 proliferative index. The patient tested positive for HIV. This report indicates the importance of immunohistochemical analysis to differentiate Burkitt's lymphoma from other similar lesions like diffuse large B-cell lymphoma. Thorough knowledge of the clinical presentation, etiopathogenesis, histopathology, and immunoprofile of intraoral HIV-associated Burkitt's lymphoma is essential among clinicians and pathologists.
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Affiliation(s)
- Mamata Kamat
- Department of Oral Pathology & Microbiology, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Sangli, India
| | - Uma Datar
- Department of Oral Pathology & Microbiology, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Sangli, India
| | | | - Sanjay Byakodi
- Department of Oral & Maxillofacial Surgery, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Sangli, India
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Guidry JT, Birdwell CE, Scott RS. Epstein-Barr virus in the pathogenesis of oral cancers. Oral Dis 2018; 24:497-508. [PMID: 28190296 PMCID: PMC5554094 DOI: 10.1111/odi.12656] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 12/28/2022]
Abstract
Epstein-Barr virus (EBV) is a ubiquitous gamma-herpesvirus that establishes a lifelong persistent infection in the oral cavity and is intermittently shed in the saliva. EBV exhibits a biphasic life cycle, supported by its dual tropism for B lymphocytes and epithelial cells, which allows the virus to be transmitted within oral lymphoid tissues. While infection is often benign, EBV is associated with a number of lymphomas and carcinomas that arise in the oral cavity and at other anatomical sites. Incomplete association of EBV in cancer has questioned if EBV is merely a passenger or a driver of the tumorigenic process. However, the ability of EBV to immortalize B cells and its prevalence in a subset of cancers has implicated EBV as a carcinogenic cofactor in cellular contexts where the viral life cycle is altered. In many cases, EBV likely acts as an agent of tumor progression rather than tumor initiation, conferring malignant phenotypes observed in EBV-positive cancers. Given that the oral cavity serves as the main site of EBV residence and transmission, here we review the prevalence of EBV in oral malignancies and the mechanisms by which EBV acts as an agent of tumor progression.
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Affiliation(s)
- Joseph T. Guidry
- Department of Microbiology and Immunology, Center for Tumor and Molecular Virology, and Feist-Weiller Cancer Center. Louisiana State University Health Sciences Center-Shreveport. Shreveport, LA 71103
| | - Christine E. Birdwell
- Department of Microbiology and Immunology, Center for Tumor and Molecular Virology, and Feist-Weiller Cancer Center. Louisiana State University Health Sciences Center-Shreveport. Shreveport, LA 71103
| | - Rona S. Scott
- Department of Microbiology and Immunology, Center for Tumor and Molecular Virology, and Feist-Weiller Cancer Center. Louisiana State University Health Sciences Center-Shreveport. Shreveport, LA 71103
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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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Hopp RN, Marchi MT, Kellermann MG, Rizo VHT, Lopes MA, Jorge J. Lymphoma mimicking a dental periapical lesion. Leuk Lymphoma 2011; 53:1008-10. [DOI: 10.3109/10428194.2011.631161] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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9
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Burkitt's Lymphoma of maxillary sinuses: review of literature and report of bilateral case. J Oral Maxillofac Surg 2009; 67:1755-63. [PMID: 19615595 DOI: 10.1016/j.joms.2009.03.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Accepted: 03/25/2009] [Indexed: 01/17/2023]
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10
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Epstein JB, Cabay RJ, Glick M. Oral malignancies in HIV disease: Changes in disease presentation, increasing understanding of molecular pathogenesis, and current management. ACTA ACUST UNITED AC 2005; 100:571-8. [PMID: 16243242 DOI: 10.1016/j.tripleo.2005.01.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2004] [Accepted: 01/10/2005] [Indexed: 11/19/2022]
Abstract
Infection with human immunodeficiency virus (HIV) and progression to acquired immune deficiency syndrome (AIDS) are associated with a vide variety of morbidities. Local and systemic diseases can develop in association with HIV infection and may manifest themselves as malignancies of the oropharynx. Advances in HIV management, fueled by increasing understanding of molecular pathogenesis, have resulted in marked changes in the prevalence of oral malignant disease. This paper discusses recent trends in the presentation and treatment of malignancies related to HIV and AIDS with an emphasis on malignancies seen in the oral cavity.
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MESH Headings
- Animals
- Antiretroviral Therapy, Highly Active
- Carcinoma, Squamous Cell/complications
- Carcinoma, Squamous Cell/epidemiology
- Carcinoma, Squamous Cell/therapy
- Carcinoma, Squamous Cell/virology
- DNA, Viral/analysis
- Developed Countries
- HIV Infections/complications
- HIV Infections/drug therapy
- Herpesvirus 4, Human/isolation & purification
- Humans
- Lymphoma, AIDS-Related/complications
- Lymphoma, AIDS-Related/epidemiology
- Lymphoma, AIDS-Related/therapy
- Mouth Neoplasms/complications
- Mouth Neoplasms/epidemiology
- Prevalence
- Sarcoma, Kaposi/complications
- Sarcoma, Kaposi/epidemiology
- Sarcoma, Kaposi/therapy
- United States/epidemiology
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Affiliation(s)
- Joel B Epstein
- Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, Chicago Cancer Center, University of Illinois at Chicago, IL 60612USA.
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11
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Chen YK, Tsu HR, Lin YJ, Lin LM. Intra-oral HIV-associated Burkitt’s lymphoma with mandible involvement. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.ooe.2005.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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12
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Mignogna MD, Fedele S, Lo Russo L, Lanza A, Marenzi G, Sammartino G. Gorham's disease of the mandible mimicking periodontal disease on radiograph. J Clin Periodontol 2005; 32:1022-6. [PMID: 16104969 DOI: 10.1111/j.1600-051x.2005.00745.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Gorham's disease is a rare disorder characterized by spontaneous and progressive osteolysis of one or more skeletal bones. The radiographic findings associated with Gorham's disease are particularly dramatic, as in some cases a complete resorption of the involved bone can occur, leading to the definition of phantom bone, vanishing bone, or disappearing bone disease. MATERIAL AND METHODS A 24-year-old female patient with a previous diagnosis of periodontal disease and progressive mandibular alveolar bone loss was referred to our Oral Medicine section. The initial radiographic picture showed infrabony defects and horizontal bone loss. RESULTS After further extensive local and systemic evaluation, including histopathological, laboratory and imagine techniques investigations, the patient was diagnosed to be affected by Gorham's disease. Meanwhile the progression of the osteolytic process had caused the loosening of all the left mandibular teeth and a pathologic fracture. Appropriate medical therapy was successful in stabilizating the resorptive process, with no evidence of further progressive disease. CONCLUSIONS When Gorham's disease involves the mandible, the role of the periodontologist is extremely important in diagnosing promptly the disorder and preventing the functional and aesthetic consequences of advanced and extensive bone loss. Gorham's disease should be included among the pathologic entities mimicking periodontal disease on radiograph, such as inflammatory disease (e.g. osteomyelitis), endocrine disease (e.g. hyperparathyroidism), intra-osseous malignancies or metastases, lymphoma, histiocytosis X, mainly eosinophilic granuloma, infective process (e.g. tuberculosis and actinomycosis), odontogenic tumours.
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Affiliation(s)
- Michele Davide Mignogna
- Department of Odontostomatological and Maxillofacial Sciences, Section of Oral Medicine, University Federico II, Naples, Italy.
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Arapakis I, Fradis M, Ridder GJ, Schipper J, Maier W. Recurrent syncope as presenting symptom of Burkitt's lymphoma at the carotid bifurcation. Ann Otol Rhinol Laryngol 2004; 113:373-7. [PMID: 15174764 DOI: 10.1177/000348940411300506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Burkitt's lymphoma is rare outside of Africa, and head and neck manifestations of this disease are even more uncommon. We report a case of Burkitt's lymphoma localized at the bifurcation of the right common carotid artery in a 64-year-old man. The presenting symptoms were recurrent syncopes that necessitated a pacemaker, followed by a rapid onset of cranial nerve palsies. The tumor had infiltrated cranial nerves IX, X, XI, and XII and was resected by selective neck dissection. The patient was subsequently treated with a chemotherapeutic regimen consisting of a combination of cytosine arabinoside, vincristine, ifosfamide, prednisone, and an intrathecal application of methotrexate. He also underwent external-beam irradiation of the neck. The patient has been followed up for a period of 42 months and has no evidence of recurrent disease. Repeated diagnostic testing and a coordination of multiple disciplines can speed diagnosis and therapeutic management. The current literature is reviewed and discussed.
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Affiliation(s)
- Iakovos Arapakis
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Freiburg, Freiburg, Germany
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Landesberg R, Yee H, Datikashvili M, Ahmed AN. Unilateral mandibular lip anesthesia as the sole presenting symptom of Burkitt's lymphoma: case report and review of literature. J Oral Maxillofac Surg 2001; 59:322-6. [PMID: 11243617 DOI: 10.1053/joms.2001.21004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- R Landesberg
- Columbia University and Bellevue Hospital Center/New York University, New York 10032, USA.
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Manganaro AM, Phillips KM. Rapidly growing periodontal enlargement. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2000; 89:535-8. [PMID: 10807707 DOI: 10.1016/s1079-2104(00)89205-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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