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Wongpattaraworakul W, Krongbaramee T, Lanzel EA, Hellstein JW, Teixeira FB. Hematolymphoid neoplasm mimicking endodontic lesions: case series and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2024:S2212-4403(24)00406-1. [PMID: 39179451 DOI: 10.1016/j.oooo.2024.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/16/2024] [Accepted: 07/20/2024] [Indexed: 08/26/2024]
Abstract
Hematolymphoid neoplasms originating in the periapical region of a tooth are rare occurrences. Their signs, symptoms, and radiographic findings can also mimic lesions of endodontic origin. History-taking and clinical examination provide clues to determine the possibility of a non-endodontic lesion, although the definitive diagnosis can only be rendered based on histologic examination. In our case series, we present four cases of hematolymphoid neoplasms that radiographically mimicked endodontic lesions. All the cases initially underwent endodontic treatment, but the lesions failed to resolve. In one case, the clinician suspected a diagnosis of lymphoma based on the patient's history. In the other cases, the clinicians' impression was that the lesions originated from endodontic issues. We present two cases of diffuse large B-cell lymphoma, a case of a plasma cell neoplasm, and a case of Langerhans cell histiocytosis, along with a literature review of three entities when found in the oral cavity as well as review of hematolymphoid neoplasm mimicking endodontic lesion previously reported in literature.
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Affiliation(s)
- Wattawan Wongpattaraworakul
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA; Division of Oral Diagnostic Sciences, Faculty of Dentistry, Thammasat University, Pathumthani, Thailand
| | - Tadkamol Krongbaramee
- Division of Endodontics, Department of Restorative Dentistry & Periodontology, Chiang Mai University, Chiang Mai, Thailand
| | - Emily A Lanzel
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA
| | - John W Hellstein
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA
| | - Fabricio B Teixeira
- Department of Endodontics, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA.
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2
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Vyas A, Chug A, Sehrawat A, Simre S, Porwal J, Kolse P. Maxillary Diffuse Large B-Cell Lymphoma Enshrouded as Osteomyelitis: A Case Report. J Maxillofac Oral Surg 2024; 23:1022-1025. [PMID: 39118903 PMCID: PMC11303643 DOI: 10.1007/s12663-024-02174-9] [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: 10/11/2023] [Accepted: 03/19/2024] [Indexed: 06/07/2024] Open
Abstract
Extranodal non-Hodgkin's lymphoma (NHL) afflicting the head and neck region is rare, accounting for only about 5%. Diffuse large B-cell lymphoma (DLBCL) is the most common type of NHL affecting the oral cavity. Due to its variable clinical presentation and non-pathognomic course, it can be easily misdiagnosed with overlapping characteristics to common oral pathologies. In the present case, the authors report an unusual presentation of DLBCL and highlight the significant diagnostic challenge encountered by the clinician. In our case, osteonecrosis of the maxilla with soft tissue swelling misleads the diagnosis of chronic osteomyelitis. However, further, work-up was pursued, and the patient was managed successfully with chemotherapy and is currently disease-free for the past 1 year. An accurate clinico-radiological diagnosis with histopathological confirmation is emphasized to deliver a potentially curative treatment in a timely manner.
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Affiliation(s)
- Akansha Vyas
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand 249203 India
| | - Ashi Chug
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand 249203 India
| | - Amit Sehrawat
- Department of Medical Oncology Haematology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand 249203 India
| | - Saurabh Simre
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand 249203 India
| | - Jasmine Porwal
- Department of Medical Oncology Haematology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand 249203 India
| | - Preeti Kolse
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand 249203 India
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3
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Kuceki G, Nguyen C, Ng D, Wada D, Mathis J. Oral diffuse large B-cell lymphoma presenting as a bland nodule. JAAD Case Rep 2023; 36:34-37. [PMID: 37215296 PMCID: PMC10195845 DOI: 10.1016/j.jdcr.2023.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Affiliation(s)
- Guilherme Kuceki
- Department of Dermatology, University of Utah, Salt Lake City, Utah
| | - Cassidy Nguyen
- Department of Dermatology, University of Utah, Salt Lake City, Utah
| | - David Ng
- Department of Pathology, University of Utah, Salt Lake City, Utah
| | - David Wada
- Department of Dermatology, University of Utah, Salt Lake City, Utah
| | - Jason Mathis
- Department of Dermatology, University of Utah, Salt Lake City, Utah
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4
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Bernardo PS, Hancio T, Vasconcelos FDC, Nestal de Moraes G, de Sá Bigni R, Wernersbach Pinto L, Thuler LCS, Maia RC. Primary diffuse large B-cell lymphoma of the head and neck in a Brazilian single-center study. Oral Dis 2023; 29:968-977. [PMID: 34905288 DOI: 10.1111/odi.14104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Lymphomas represent around 10% of head and neck neoplasms, among which the diffuse large B-cell lymphoma (DLBCL) is the most common histologic subtype. In the present study, we characterized demographic parameters, anatomical sites, and survival rates of patients in a Brazilian cancer center. MATERIALS AND METHODS Single-center retrospective epidemiological study of 243 head and neck DLBCL patients. Demographic characteristics, tumor localization, HIV status, lactate dehydrogenase (LDH) activity, and treatment modality were obtained from electronic medical records. RESULTS The most common primary head and neck tumor location in patients with DLBCL was Waldeyer's ring. Interestingly, age above 80 years, male gender, high LDH levels, and HIV positivity were significantly associated with shorter overall survival (OS) rates and increased risk of death. We further demonstrated that treatment had a protective effect, improving OS, and reducing risk of death. Notably, we found no benefit of combination of chemotherapy and radiotherapy versus isolated treatment modalities. CONCLUSION The study showed that primary head and neck DLBCL is more incident in middle age and elderly patients with a small male patients' majority in a Brazilian population. Moreover, we observed a 3-year OS rate of almost 60% and multivariate analysis showed that treatment was the only protective factor.
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Affiliation(s)
- Paula Sabbo Bernardo
- Laboratório de Hemato-Oncologia Celular e Molecular, Programa de Hemato-Oncologia Molecular, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
| | - Thaís Hancio
- Laboratório de Hemato-Oncologia Celular e Molecular, Programa de Hemato-Oncologia Molecular, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
| | - Flavia da Cunha Vasconcelos
- Laboratório de Hemato-Oncologia Celular e Molecular, Programa de Hemato-Oncologia Molecular, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
| | - Gabriela Nestal de Moraes
- Laboratório de Hemato-Oncologia Celular e Molecular, Programa de Hemato-Oncologia Molecular, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
- Instituto de Bioquímica Médica Leopoldo de Meis, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | | | | | - Raquel Ciuvalschi Maia
- Laboratório de Hemato-Oncologia Celular e Molecular, Programa de Hemato-Oncologia Molecular, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
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5
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de Araújo GR, Morais-Perdigão AL, de Cáceres CVBL, Lopes MA, Aguirre-Urizar JM, Carlos R, Tager EMJR, van Heerden WFP, Robinson L, Pontes HAR, de Andrade BAB, Soares CD, Gomez RS, Fonseca FP. Lymphomas Affecting the Sublingual Glands: A Clinicopathological Study. Head Neck Pathol 2023; 17:154-164. [PMID: 36166159 PMCID: PMC10063706 DOI: 10.1007/s12105-022-01489-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/12/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Lymphomas affecting the sublingual glands are extremely rare and very few case reports are currently available. Therefore, the aim of the current study is to describe the clinicopathological features of a series of lymphomas involving the sublingual glands. METHODS Cases diagnosed in four pathology services were assessed and the formalin-fixed paraffin-embedded tissue blocks were retrieved for diagnosis confirmation. Clinical data were obtained from patients' medical files. RESULTS We obtained seven cases of lymphomas in the sublingual glands, representing two follicular lymphomas, two diffuse large B cell lymphomas not otherwise specified (DLBCL NOS), two extranodal marginal zone B cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphomas) and one mantle cell lymphoma (MCL). In all cases the tumor cells infiltrated the glandular parenchyma, although in two of them the neoplastic cells were located more superficially and permeated the glandular acini and ducts. Clinically, the tumors presented as asymptomatic nodules and two patients (affected by DLBCL NOS and MCL) died, while the other five patients remained alive at last follow-up. CONCLUSION Lymphomas affecting the sublingual glands are usually of the mature B cell lineage, often represent low-grade subtypes and may clinically resemble other more common lesions in the floor of the mouth like salivary gland tumors.
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Affiliation(s)
- Gabriela Ribeiro de Araújo
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Av. Antônio Carlos, Belo Horizonte, 6627, Brazil
| | - Ana Luísa Morais-Perdigão
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Av. Antônio Carlos, Belo Horizonte, 6627, Brazil
| | | | - Márcio Ajudarte Lopes
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | | | - Roman Carlos
- Centro Clínico de Cabeza Y Cuello, Guatemala City, Guatemala
| | - Elena María José Román Tager
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
- Centro Clínico de Cabeza Y Cuello, Guatemala City, Guatemala
| | - Willie F P van Heerden
- Department of Oral Biology and Oral Pathology, University of Pretoria, Pretoria, South Africa
| | - Liam Robinson
- Department of Oral Biology and Oral Pathology, University of Pretoria, Pretoria, South Africa
| | - Hélder Antônio Rebelo Pontes
- Service of Oral Pathology, João de Barros, Barreto University Hospital, Federal University of Pará, Belém, Brazil
| | | | - Ciro Dantas Soares
- Private Pathology Service, Getúlio Sales Diagnósticos, Natal, RN, Brasil
| | - Ricardo Santiago Gomez
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Av. Antônio Carlos, Belo Horizonte, 6627, Brazil
| | - Felipe Paiva Fonseca
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Av. Antônio Carlos, Belo Horizonte, 6627, Brazil.
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil.
- Department of Oral Biology and Oral Pathology, University of Pretoria, Pretoria, South Africa.
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Schwerzmann MC, Dettmer MS, Baumhoer D, Iizuka T, Suter VGA. A rare low-grade myofibroblastic sarcoma in lower jaw with the resemblance to benign lesions. BMC Oral Health 2022; 22:380. [PMID: 36064342 PMCID: PMC9446721 DOI: 10.1186/s12903-022-02381-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 08/05/2022] [Indexed: 11/24/2022] Open
Abstract
Background Low-grade myofibroblastic sarcoma (LGMS) is a rare solid infiltrative soft tissue tumor with a predilection for the head and neck region. Case presentation We report the diagnostic steps of a fast-growing lesion of the lower left jaw in a 45-year-old otherwise healthy woman. A first biopsy and subsequent histopathological examination showed potential differentials of a benign myofibroma, benign nodular fasciitis or an LGMS. This diagnostic overlap was a challenge for the decision of the further treatment approach. The treatment consisted of a segmental en bloc resection of the mandible including the second premolar, first and second molar. Histopathological examination of the resected tumor confirmed an LGMS. Conclusion The histopathologic resemblance of LGMS to a range of benign and reactive tumors may lead to misdiagnosis and mistreatment. The rarity of LGMS explains the lack of established treatment protocols. This case shows the importance of adequate clinical decisions, expertise in the histopathology of rare tumors and interdisciplinary exchange to achieve state-of-the-art patient management.
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Affiliation(s)
- Martina C Schwerzmann
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.,Clinic for Oral and Maxillofacial Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Matthias S Dettmer
- Institute of Pathology, University Bern, Bern, Switzerland.,Institute of Pathology, Klinikum Stuttgart, Stuttgart, Germany
| | - Daniel Baumhoer
- Bone Tumour Reference Center at the Institute of Pathology, University and University Hospital Basel, Basel, Switzerland
| | - Tateyuki Iizuka
- Department of Cranio-Maxillofacial Surgery, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Valerie G A Suter
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.
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7
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Liu Y, Wang Y, Wang P, Yu Q. A retrospective study to evaluate the CT and MR imaging findings of non-Hodgkin's lymphoma affecting the jaw bones. Oral Radiol 2022; 38:509-516. [PMID: 35032248 DOI: 10.1007/s11282-021-00582-y] [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: 10/08/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To explore the CT and MR imaging findings of non-Hodgkin's lymphoma (NHL) involving the jaw bones. METHODS Gnathic NHLs were retrospectively analyzed in 52 patients. The imaging findings were observed from the lesion number, location, size, shape, margin, density and signal intensity, CT value, bone structure change, and soft tissue mass. RESULTS Of the 52 subjects, there were 43 with solitary gnathic NHL, and 9 with multicentric gnathic NHLs. The maximum diameter of all the 72 lesions ranged from 1.5 to 9.5 cm (mean 4.6 ± 1.67 cm). Of the 72 lesions, 90.3% were identified as irregular shapes, 87.5% as ill-defined margins, and 76.4% as homogeneous densities and signal intensities. The osteolytic destruction was found in 84.7% lesions, cortical disruption in 84.7%, and no periosteal reaction in 93.1%. The soft tissue masses surrounding the gnathic lesions were shown in 93.1% lesions. On MR imaging, the gnathic NHLs (18 lesions) showed as iso-signal intensity on T1WI, slightly higher signal intensity on T2WI, and high signal intensity on DWI. After contrast media administration, 83.3% lesions showed slightly homogeneous enhancement on T1WI. CONCLUSIONS On CT and MR imaging, gnathic NHLs usually reveal as osteolytic lesions with irregular shapes, ill-defined margins, homogeneous densities and signal intensities, and surrounded by soft tissue mass. Some gnathic NHLs are characterized by multicentricity, which is important for indicating the condition.
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Affiliation(s)
- Yu Liu
- Department of Radiology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, ZhiZaoJu Road, Shanghai, 200011, China
| | - Yuanjun Wang
- Institute of Medical Imaging and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Pingzhong Wang
- Department of Radiology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, ZhiZaoJu Road, Shanghai, 200011, China.
| | - Qiang Yu
- Department of Radiology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, ZhiZaoJu Road, Shanghai, 200011, China.
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8
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Liu K, Gao Y, Han J, Han X, Shi Y, Liu C, Li J. Diffuse Large B-Cell Lymphoma of the Mandible Diagnosed by Metagenomic Sequencing: A Case Report. Front Med (Lausanne) 2022; 8:752523. [PMID: 35004723 PMCID: PMC8732773 DOI: 10.3389/fmed.2021.752523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/06/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction: Non-Hodgkin lymphoma (NHL) has a much higher incidence rate than Hodgkin lymphoma. Approximately 40% NHL occurs in extranodal tissues or organs, and its clinical manifestations are often nonspecific. Primary bone NHL involving the mandible is an uncommon NHL that is characterized by fever, gum swelling and toothache. Therefore, it is often misdiagnosed as oral diseases. Case Presentation: A 52-year-old female had recurrent fever for more than 1 month, with numbness in her left jaw and toothache. PET/CT showed an uptake area in the left mandible, suggesting microbial infections. However, antibacterial, and antiviral treatment were ineffective. Furthermore, metagenomic sequencing of plasma reported no pathogens, but instead showed significant copy number variations of multiple chromosomes, which highly suggested the existence of tumor. Finally, diffuse large B-cell lymphoma (DLBCL) was diagnosed by mandibular biopsy, and the patient was transferred to Hematology department for chemotherapy. Conclusion: mNGS not only assists rapid etiological diagnosis, but also helps rule out infection and diagnose malignant neoplasm.
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Affiliation(s)
- Kaili Liu
- Department of General Medical Ward, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yang Gao
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Jiawei Han
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xu Han
- Department of Medical, Hangzhou Matridx Biotechnology Co., Ltd, Hangzhou, China
| | - Yingqi Shi
- Department of Medical, Hangzhou Matridx Biotechnology Co., Ltd, Hangzhou, China
| | - Chao Liu
- Department of Medical, Hangzhou Matridx Biotechnology Co., Ltd, Hangzhou, China
| | - Jie Li
- Department of General Medical Ward, First Affiliated Hospital of Soochow University, Suzhou, China
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Morais-Perdigão AL, Rodrigues-Fernandes CI, Araújo GR, Soares CD, de Andrade BAB, Martins MD, Vargas PA, Pontes HAR, Pires FR, Burbano RMR, Fonseca FP. CD30 Expression in Oral and Oropharyngeal Diffuse Large B Cell Lymphoma, not Otherwise Specified. Head Neck Pathol 2021; 16:476-485. [PMID: 34655411 PMCID: PMC9187795 DOI: 10.1007/s12105-021-01387-5] [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: 07/06/2021] [Accepted: 10/06/2021] [Indexed: 12/24/2022]
Abstract
Diffuse large B cell lymphoma, not otherwise specified (DLBCL, NOS) is the most frequent non-Hodgkin lymphoma subtype. This aggressive neoplasm may variably express the CD30 protein, which may be used as a therapeutic target for this tumor. However, CD30 expression in DLBCL NOS arising from the oral cavity and the oropharynx has not been investigated. Therefore, this study aims to determine the frequency of CD30 expression and its prognostic significance for patients affected by oral/oropharyngeal DLBCL NOS. Fifty cases were retrieved from pathology files and submitted to immunohistochemistry against CD30. Reactivity was accessed by two oral pathologists using two cut-off values (> 0% and > 20% of tumor cells) to determine positivity in each case. Clinical data were obtained from the patients' medical files to investigate the prognostic potential of the protein. Seven high-grade B cell lymphomas and two EBV-positive DLBCL NOS were identified. We found one CD30-positive case in each of these two groups of lymphomas. Among the remaining 41 DLBCL NOS, other four cases (three in the oral cavity and one in the oropharynx) were positive for CD30, but only two expressed the protein in > 20% of tumor cells, both in the oral cavity. Survival analysis demonstrated that CD30-positive cases had a higher five-year overall survival rate (75%) than CD30-negative cases (32.3%), although a statistically significant result was not achieved (p = 0.19). Only a minor subset of oral and oropharyngeal DLBCL NOS express CD30 and these patients seems to have a higher survival rate.
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Affiliation(s)
- Ana Luísa Morais-Perdigão
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, 31270-901, Pampulha, Belo Horizonte, Brazil
| | | | - Gabriela Ribeiro Araújo
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, 31270-901, Pampulha, Belo Horizonte, Brazil
| | | | | | - Manoela Domingues Martins
- Department of Pathology, School of Dentistry, Federal University of Rio Grande Do Sul, Porto Alegre, Brazil
| | - Pablo Agustin Vargas
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil ,Department of Oral Biology and Oral Pathology, University of Pretoria, Pretoria, South Africa
| | - Hélder Antônio Rebelo Pontes
- Service of Oral Pathology, João de Barros, Barreto University Hospital, Federal University of Pará, Belem, Brazil
| | - Fábio Ramôa Pires
- Oral Pathology, Dental School, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | - Felipe Paiva Fonseca
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, 31270-901, Pampulha, Belo Horizonte, Brazil ,Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil ,Department of Oral Biology and Oral Pathology, University of Pretoria, Pretoria, South Africa
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10
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de Andrade BAB, Silva Cunha JL, Abrahão AC, Agostini M, Corrêa Roza ALO, de Almeida OP, de Castro LA, Romañach MJ. A dome-shaped nodule on unattached alveolar mucosa. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 133:502-508. [PMID: 34753691 DOI: 10.1016/j.oooo.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Affiliation(s)
| | - John Lennon Silva Cunha
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil.
| | - Aline Corrêa Abrahão
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Michelle Agostini
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | - Oslei Paes de Almeida
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Luciano Alberto de Castro
- Department of Stomatological Sciences, School of Dentistry, Federal University of Goiás (UFG), Goiânia, Brazil
| | - Mário José Romañach
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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11
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de Arruda JAA, Schuch LF, Conte Neto N, de Souza LL, Rodrigues-Fernandes CI, Abreu LG, Soares CD, de Carvalho MGF, Agostini M, de Andrade BAB, Romañach MJ, Zanella VG, Barra MB, Martins MD, Souto GR, Etges A, Pontes HAR, Pontes FSC, Vargas PA, de Almeida OP, Santos-Silva AR, Lopes MA, Pires FR, Gomez RS, Fonseca FP, Mesquita RA. Oral and oropharyngeal lymphomas: A multi-institutional collaborative study. J Oral Pathol Med 2021; 50:603-612. [PMID: 34091952 DOI: 10.1111/jop.13211] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Lymphomas in the oral and oropharyngeal regions are relatively uncommon, and their diagnosis is challenging and complex due to the myriad histopathological subtypes. Herein, we report a large series of oral and oropharyngeal lymphomas and compare our data with the currently available literature. METHODS All cases diagnosed as lymphomas affecting the oral and oropharyngeal regions were retrospectively retrieved from seven Brazilian institutions. Clinicodemographic data and histopathological features were evaluated and described, while a comprehensive literature review was undertaken in order to compare our findings. RESULTS A total of 304 cases of oral and oropharyngeal lymphomas were obtained, mostly affecting individuals aged 60-69 years (n = 68) with a mean age at diagnosis of 54.2 ± 20.1 years. Males and females were equally affected. Mature B-cell neoplasms (87.2%) were the most common group, followed by mature T- and NK-cell neoplasms (11.2%) and precursor lymphoid neoplasms (1.6%). The most frequent subtypes in each group were diffuse large B-cell lymphomas, not otherwise specified (n = 99), extranodal NK/T-cell lymphomas, nasal type (n = 12), and B-lymphoblastic leukaemia/lymphomas, not otherwise specified (n = 4). The most commonly involved sites were the palate (26.3%), mandible (13%), and maxilla (10.5%). CONCLUSION Diffuse large B-cell lymphoma, not otherwise specified, remains the most common subtype of lymphomas in the oral and oropharyngeal region. Older patients are the most affected, with no gender predilection and the palate and jaw are usually affected.
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Affiliation(s)
- José Alcides Almeida de Arruda
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Lauren Frenzel Schuch
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Department of Oral Diagnosis, Piracicaba Dental School, Universidade de Campinas, Piracicaba, Brazil
| | - Nicolau Conte Neto
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Lucas Lacerda de Souza
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade de Campinas, Piracicaba, Brazil
| | | | - Lucas Guimarães Abreu
- Department of Child's and Adolescent's Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Michelle Agostini
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Mário José Romañach
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Virgilio Gonzales Zanella
- Department of Head and Neck Surgery, Hospital Santa Rita, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | - Marinez Bizarro Barra
- Service of Pathology, Hospital Santa Rita, Santa Casa de Misericórdia, Porto Alegre, Brazil
| | - Manoela Domingues Martins
- Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Oral Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Giovanna Ribeiro Souto
- Department of Dentistry, Pontifícia Universidade Católica de Minas Gerais, Belo Horizonte, Brazil
| | - Adriana Etges
- Diagnostic Centre for Oral Diseases, School of Dentistry, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Hélder Antônio Rebelo Pontes
- Service of Oral Pathology, Hospital Universitário João de Barros Barreto, Universidade Federal do Pará, Belém, Brazil
| | | | - Pablo Agustin Vargas
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade de Campinas, Piracicaba, Brazil
| | - Oslei Paes de Almeida
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade de Campinas, Piracicaba, Brazil
| | - Alan Roger Santos-Silva
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade de Campinas, Piracicaba, Brazil
| | - Marcio Ajudarte Lopes
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade de Campinas, Piracicaba, Brazil
| | - Fábio Ramôa Pires
- Department of Oral Pathology, School of Dentistry, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ricardo Santiago Gomez
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Felipe Paiva Fonseca
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ricardo Alves Mesquita
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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12
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Rodrigues-Fernandes CI, Abreu LG, Radhakrishnan R, Perez DEDC, Amaral-Silva GK, Gondak RDO, Rahimi S, Brennan PA, Fonseca FP, Vargas PA. Prognostic significance of CD30 expression in diffuse large B-cell lymphoma: A systematic review with meta-analysis. J Oral Pathol Med 2021; 50:587-593. [PMID: 34101913 DOI: 10.1111/jop.13208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND CD30 is variably expressed in diffuse large B-cell lymphoma (DLBCL), but its prognostic potential for the affected patients remains debatable and unclear. Therefore, we aimed to determine the frequency of CD30 expression in DLBCL and its potential for prognostic determination. METHODS An electronic systematic review was performed using multiple databases, followed by a quantitative meta-analysis to assess the frequency of CD30 expression with positivity cut-off values of >0% and >20%, and to determine its association with clinicopathological features and patients' survival. RESULTS Using a cut-off value >0%, we observed that 3.5%-59.1% of the cases were considered positive for CD30. There was a significant association of the protein expression with a lower number of extra-nodal sites affected by the neoplasm, with Ann Arbor advanced stage, the absence of B-symptoms, the lack of MYC and BCL2 translocations, and a lower ECOG performance. Using a cut-off value >20%, we observed that 2.5%-36.7% of the cases were considered positive for CD30, being significantly associated with a lower number of extra-nodal sites affected by the neoplasm, Ann Arbor stages III/IV, non-GCB tumours, the lack of MYC and BCL2 translocations, and a lower ECOG value. CD30 expression was significantly associated with a better survival rate, regardless of what cut-off parameter was used. CONCLUSION Despite variations in the cut-off values used to determine CD30 positivity in DLBCL, the expression of this protein seems to be associated with a higher survival rate and better prognosis.
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Affiliation(s)
| | - Lucas Guimarães Abreu
- Department of Child's and Adolescent's Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Raghu Radhakrishnan
- Department of Oral Pathology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Danyel Elias da Cruz Perez
- Department of Clinical and Preventive Dentistry, School of Dentistry, Universidade Federal de Pernambuco, Recife, Brazil
| | | | | | - Siavash Rahimi
- Department of Pathology, Queen Alexandra Hospital, Portsmouth, UK
| | - Peter A Brennan
- Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - Felipe Paiva Fonseca
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil.,Department of Oral Biology and Oral Pathology, School of Dentistry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Pablo Agustin Vargas
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil.,Department of Oral Biology and Oral Pathology, School of Dentistry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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13
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Nosrat A, Verma P, Glass S, Vigliante CE, Price JB. Non-Hodgkin Lymphoma Mimicking Endodontic Lesion: A Case Report with 3-dimensional Analysis, Segmentation, and Printing. J Endod 2021; 47:671-676. [PMID: 33493549 DOI: 10.1016/j.joen.2021.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/04/2021] [Accepted: 01/12/2021] [Indexed: 12/29/2022]
Abstract
Non-Hodgkin lymphoma (NHL) of the oral cavity can present with pain, swelling and radiolucent lesion mimicking endodontic diseases. This article reports on a case of diffuse large B-cell lymphoma initially diagnosed and treated as periodontal disease and then endodontic disease in the maxillary anterior and premolar area of a 40-year old female. A cone beam computed tomography (CBCT) image of the lesion was taken. The lesion was segmented using Mimics software (Materialise NV, Lueven, Belgium). Three-dimensional models of the tumor were printed. During the surgical phase teeth #4, 6, and 7 were extracted and biopsy samples were obtained. Histopathologic examination showed invasive sheets of large, atypical, basophilic cells strongly and diffusely positive for CD20. Three-dimensional analysis, segmentation, and printing of radiolucent lesions of the jaws assists with differential diagnosis and efficient treatment. Oral health professionals can play a crucial role in the early detection and diagnosis of oral NHL, thereby preventing extensive loss of function and esthetics, and even saving lives.
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Affiliation(s)
- Ali Nosrat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, Baltimore, Maryland; Private Practice, Centerville Endodontics, Centreville, Virginia.
| | - Prashant Verma
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, Baltimore, Maryland; Private Practice, Centerville Endodontics, Centreville, Virginia
| | - Sarah Glass
- Department of Oral Diagnostic Sciences, School of Dentistry, Virginia Commonwealth University, Richmond, Virginia
| | - Craig E Vigliante
- Private Practice, Potomac Surgical Arts, PC, Leesburg, Virginia; Reston Advanced Oral and Cosmetic Facial Surgery, LLC, Reston, Virginia
| | - Jeffery B Price
- Department of Oncology and Diagnostic Sciences, School of Dentistry, University of Maryland, Baltimore, Maryland
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14
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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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15
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Huang S, Messeca C, Remangeon F, Famery C. Diagnostic difficulty of a mandibular manifestation of diffuse large B-cell lymphoma: a case report. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2020. [DOI: 10.1051/mbcb/2020041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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16
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Xia S, Yue J, Chen X, Hu Y, Guo F, Zhang J. Clinicopathological and genetic characteristics of diffuse large B-cell lymphoma of the oropharyngeal and maxillofacial region. Oral Dis 2020; 27:448-456. [PMID: 32731312 DOI: 10.1111/odi.13578] [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: 04/03/2020] [Revised: 06/23/2020] [Accepted: 07/14/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The study was aimed to analyze the clinicopathological and molecular pathological features of diffuse large B-cell lymphoma (DLBCL) in the oropharyngeal and maxillofacial region. SUBJECTS AND METHODS A retrospective review was performed with 36 patients who were diagnosed with primary DLBCL of the oropharyngeal and maxillofacial region from 2009 to 2017 in the Department of Pathology at the Hospital of Stomatology, Wuhan University. Immunohistochemistry and fluorescence in situ hybridization were performed. RESULTS Gene rearrangements of BCL2, BCL6, and MYC were observed in 5.6%, 33.3%, and 22.2%, respectively, including two double-hit and one triple-hit DLBCL (8.3%). There was a significant correlation between MYC protein expression and gene translocation (rs = 0.679, p < .001). However, 25% of cases with MYC rearrangement showed low MYC protein expression. In univariate analysis, MYC protein expression, BCL2 rearrangement, MYC rearrangement, and double/triple-hit DLBCL were associated with shorter overall survival, whereas only MYC protein expression was an independent prognostic value in multivariate model. CONCLUSIONS MYC protein expression was an essential prognostic marker of DLBCL in the oropharyngeal and maxillofacial region. Notably, immunohistochemical staining of MYC, BCL2, and BCL6 could not predict their gene rearrangements, although MYC protein expression was correlated with gene translocation.
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Affiliation(s)
- Shu Xia
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei_MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China.,Oral Histopathology Department, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Junqiu Yue
- Department of Pathology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinming Chen
- Oral Histopathology Department, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Yaying Hu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei_MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China.,Oral Histopathology Department, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Fang Guo
- Department of Pathology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiali Zhang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei_MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China.,Oral Histopathology Department, School and Hospital of Stomatology, Wuhan University, Wuhan, China
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17
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Rodrigues-Fernandes CI, Pérez-de-Oliveira ME, Aristizabal Arboleda LP, Fonseca FP, Lopes MA, Vargas PA, Santos-Silva AR. Clinicopathological analysis of oral Burkitt's lymphoma in pediatric patients: A systematic review. Int J Pediatr Otorhinolaryngol 2020; 134:110033. [PMID: 32302884 DOI: 10.1016/j.ijporl.2020.110033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/30/2020] [Accepted: 03/30/2020] [Indexed: 01/19/2023]
Abstract
The aim of this study was to integrate the available data regarding pediatric Burkitt's lymphoma (BL) of the oral cavity. A systematic review was conducted following PRISMA guidelines, through a specific search strategy. Twenty-nine publications were included in this study, resulting in a total of 144 cases. Oral BL was predominantly found in males (75.7%). The mandible was the most involved site (37.5%), and all cases clinically exhibited a swelling. Presence of EBV was observed in 33.3% of the cases, and 4 cases reported HIV-positive patients (33.3%). Chemotherapy was the leading treatment choice for oral BL (94.9%), and the overall 5-year survival was 54.3%. Regarding the quality assessment of the studies, most (19 studies; 65.5%) were classified as an overall moderate risk of bias. In conclusion, the clinicopathological characteristics of oral BL in the pediatric population comprise the sporadic and intermediate subtypes. Despite its aggressiveness, this malignancy presents a moderate overall survival.
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Affiliation(s)
- Carla Isabelly Rodrigues-Fernandes
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas, 13414-903, Piracicaba, São Paulo, Brazil
| | - Maria Eduarda Pérez-de-Oliveira
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas, 13414-903, Piracicaba, São Paulo, Brazil
| | - Lady Paola Aristizabal Arboleda
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas, 13414-903, Piracicaba, São Paulo, Brazil
| | - Felipe Paiva Fonseca
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas, 13414-903, Piracicaba, São Paulo, Brazil; Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, 31270-901, Belo Horizonte, Brazil; Department of Oral Biology and Oral Pathology, University of Pretoria, Pretoria, South Africa
| | - Márcio Ajudarte Lopes
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas, 13414-903, Piracicaba, São Paulo, Brazil
| | - Pablo Agustin Vargas
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas, 13414-903, Piracicaba, São Paulo, Brazil; Department of Oral Biology and Oral Pathology, University of Pretoria, Pretoria, South Africa
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas, 13414-903, Piracicaba, São Paulo, Brazil.
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