Mandibular non-Hodgkin's lymphoma: two observations of a challenging disease

An evidence based immunohistochemical panel for diagnosing oral lymphoma along with a case series

Oral lymphomas are rare and present a diagnostic challenge. Immunophenotyping is essential to decipher their biology and identify therapeutic targets. Histopathology can prove to be diagnostically difficult to type these lesions, and hence, immunohistochemistry (IHC) proves useful in deciphering their biology. Here, we present an evidence-based approach using a novel immunohistochemical marker panel to diagnose oral lymphomas by discussing four unique cases.

Diffuse Large B-Cell Lymphoma of the Mandible Diagnosed by Metagenomic Sequencing: A Case Report

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.