Lymphoma presenting as a toothache: a wolf in sheep's clothing

Delayed diagnosis of oral lymphoma: a case series

Lymphomas are the second most common neoplasm in the head and neck. The clinical and radiographic presentation of non-Hodgkin lymphoma in the oral cavity is non-specific and can be hard to differentiate from other common infectious or inflammatory conditions. We report four cases of lymphoma of the head and neck, which presented as odontogenic infection, osteomyelitis, or cutaneous infection, and subsequently led to a delay in provision of appropriate treatment. Correlation between clinical, radiographic and histological findings is essential in reaching an accurate diagnosis. It is important for clinicians to consider malignant lesions, such as lymphoma, in the differential diagnosis of pain, swelling, tooth mobility or radiographic radiolucencies. Clinicians should maintain a high level of suspicion for malignancy when inflammatory lesions fail to respond to normal modes of treatment.

Primary Extra Nodal Diffuse Large B-Cell Lymphoma of the Maxillary Sinus with Symptoms of Acute Pulpitis

Diffuse large B-cell lymphoma not otherwise specified (DLBCL-NOS) is a subtype of large B-cell non-Hodgkin lymphoma with various clinical and pathological manifestations. DLBCL-NOS which primarily arises from maxillary sinus is rare and hard to diagnose due to unique anatomy. Here, we present a case of DLBCL-NOS that developed in the left maxillary sinus of a 72-year-old male, who presented with severe toothache that resembled acute pulpitis. The lesion was diagnosed and treated based on radiographs, histological, immunohistological examinations, and PET-CT analysis. Despite its rare incidence, DLBCL-NOS should still be included in differential diagnoses to rule out malignancy in cases of endodontic disease.

A retrospective study to evaluate the CT and MR imaging findings of non-Hodgkin's lymphoma affecting the jaw bones

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.

Unusual cause of tooth mobility

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.