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Wagner VP, Rodrigues-Fernandes CI, Carvalho MVR, Dos Santos JN, Barra MB, Hunter KD, Aguirre-Urizar JM, van Heerden WFP, Vargas PA, Fonseca FP, Martins MD. Mantle cell lymphoma, malt lymphoma, small lymphocytic lymphoma, and follicular lymphoma of the oral cavity: An update. J Oral Pathol Med 2021; 50:622-630. [PMID: 34101256 DOI: 10.1111/jop.13214] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although uncommon, mature small B-cell lymphomas may arise in the oral/maxillofacial area and oral pathologists must be aware of the key characteristics of these neoplasms to perform an accurate diagnosis. In this manuscript, we attempted to integrate the currently available data on the clinicopathological features of follicular lymphoma (FL), mantle cell lymphoma (MCL), extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT-L), and chronic lymphocytic leukemia/ small lymphocytic lymphoma (CLL/SLL) affecting these anatomical regions. METHODS An updated descriptive literature review was carried out and a detailed electronic search was done in multiple databases to gather all cases affecting the oral/maxillofacial region and palatine tonsils. RESULTS We observed that MALT-L was the most frequently reported subtype, followed by FL, MCL, and CLL/SLL. The palate was affected in a high proportion of cases and the most usual clinical presentation was an asymptomatic swelling. MALT-L and CLL/SLL neoplastic cells were strongly associated with small salivary glands. FL showed no gender preference, while MCL and CLL/SLL were more prevalent in males and MALT-L in females. Overall, cases were more common in elderly individuals. Patients' treatment and outcome varied, with MCL being the most aggressive neoplasm with a dismal prognosis in comparison to FL and MALT-L. CONCLUSION Despite the poor documentation in many of the cases available, especially regarding the microscopic and molecular features of tumors, this review demonstrated that the oral mature small B-cell lymphomas investigated share similar clinical presentation, but carry different prognostic significance, demanding an accurate diagnosis.
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Affiliation(s)
- Vivian Petersen Wagner
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil.,Academic Unit of Oral and Maxillofacial Medicine and Pathology, Department of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | | | | | - Jean Nunes Dos Santos
- Department of Oral Pathology, School of Dentistry, Federal University of Bahia, Salvador, Brazil
| | | | - Keith D Hunter
- Academic Unit of Oral and Maxillofacial Medicine and Pathology, Department of Clinical Dentistry, University of Sheffield, Sheffield, UK.,Department of Oral Biology and Pathology, School of Dentistry, University of Pretoria, Pretoria, South Africa
| | - Jose Manuel Aguirre-Urizar
- Unit of Oral Pathology and Medicine, Department of Stomatology II, University of the Basque Country/EHU, Leioa, Spain
| | - Willie F P van Heerden
- Department of Oral Biology and Pathology, School of Dentistry, University of Pretoria, Pretoria, South Africa
| | - Pablo Agustin Vargas
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil.,Department of Oral Biology and Pathology, School of Dentistry, University of Pretoria, Pretoria, South Africa
| | - Felipe Paiva Fonseca
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil.,Department of Oral Biology and Pathology, School of Dentistry, University of Pretoria, Pretoria, South Africa.,Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Manoela Domingues Martins
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil.,Department of Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Mazur MD, Ravindra VM, Alashari M, Raetz E, Poppe MM, Bollo RJ. Primary T cell central nervous system lymphoblastic lymphoma in a child: case report and literature review. Childs Nerv Syst 2015; 31:977-84. [PMID: 25681952 DOI: 10.1007/s00381-015-2633-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 02/03/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE Primary central nervous system lymphoma (PCNSL) of T cell origin is rare in pediatric patients. We report a case of T cell PCNSL in a 12-year-old boy and review the literature to highlight the importance of brain biopsy to definitively establish the diagnosis when PCNSL is suspected. CASE REPORT A 12-year-old boy presented with worsening left-sided weakness, nausea, vomiting, headache, blurred vision, and diplopia. Magnetic resonance imaging revealed right parietal gyral thickening with faint meningeal contrast enhancement. No clear diagnosis was identified after serum testing, cerebrospinal fluid analysis, and cerebral angiography. To establish the diagnosis definitively, a right craniotomy and open, frameless stereotactic biopsy were performed, which yielded the diagnosis of lymphoblastic T cell lymphoma. CONCLUSIONS PCNSL of T cell origin in children remains poorly studied, with only 18 detailed cases reported over the last three decades, including this case. Establishing a definitive diagnosis of PCNSL is challenging, and a brain biopsy is often required to obtain enough tissue for pathological analysis. Increasing awareness and identification of children diagnosed with T cell PCNSL is needed to better understand the molecular biology of this disease and develop more standardized treatment regimens.
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Affiliation(s)
- Marcus D Mazur
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Primary Children's Hospital, University of Utah, 100 North Mario Capecchi Drive, Suite 1475, Salt Lake City, UT, 84113-1100, USA
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The recognition and classification of lymphoproliferative disorders of the gut. Hum Pathol 2013; 45:899-916. [PMID: 24613566 DOI: 10.1016/j.humpath.2013.12.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 12/04/2013] [Accepted: 12/05/2013] [Indexed: 12/12/2022]
Abstract
Gastrointestinal lymphomas can be difficult to diagnose, particularly in small samples, when early in development, or when of unusual types. In this review, we describe lymphoid proliferations in the gastrointestinal tract in a location-based manner, including, mouth, esophagus, stomach, small intestine, and large bowel. For the purpose of differential diagnosis, benign mimics of lymphoma are also described. Lymphoma types that are specifically addressed include plasmablastic, extranodal natural killer/T-cell-nasal type, extranodal marginal zone lymphoma (eg, mucosa-associated lymphoid tissue lymphoma), diffuse large B cell, primary follicular of small intestine, enteropathy-associated T cell, and Burkitt and mantle cell. Immunohistochemical markers useful in the diagnostic approach are elaborated in detail.
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Lynch DW, Verma R, Larson E, Geis MC, Jassim AD. Primary cutaneous mantle cell lymphoma with blastic features: report of a rare case with special reference to staging and effectiveness of chemotherapy. J Cutan Pathol 2011; 39:449-53. [PMID: 22121909 DOI: 10.1111/j.1600-0560.2011.01832.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We describe a case of blastic primary cutaneous mantle cell lymphoma (MCL) in an 83-year-old male with a complex medical history. The patient presented to his primary care physician with a nodular erythematous skin eruption on his thighs. Histopathologic examination showed a diffuse lymphoid infiltrate of intermediate to large cells that involved the dermis and subcutis but spared the epidermis. Immunohistochemical staining showed expression of CD20, CD5 and cyclin-D1. The lymphoma cells were negative for CD10 and CD23. Fluorescence in situ hybridization (FISH) analysis revealed a characteristic translocation [t(11;14)(q13;q32)], which is diagnostic of MCL. Cutaneous involvement by MCL is typically secondary because of widespread disease, and primary cutaneous MCL can only be diagnosed in the absence of extracutaneous involvement. Primary cutaneous MCL is extremely rare and requires proper clinical staging. In this case, clinical staging revealed no evidence of bone marrow or peripheral blood involvement, and positron emission tomography (PET) scan revealed weak, abnormal uptake only in a few cervical lymph nodes. Because of the lack of disseminated involvement, we favor the lesion to be a primary cutaneous MCL.
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Affiliation(s)
- Douglas W Lynch
- Department of Pathology, Sanford School of Medicine of the University of South Dakota, Sioux Falls, SD 57106, USA
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Ianotto JC, Tempescul A, Eveillard JR, André N, Morel F, Quintin-Roué I, Berthou C. Acute dyspnoea and single tracheal localisation of mantle cell lymphoma. J Hematol Oncol 2010; 3:34. [PMID: 20920203 PMCID: PMC2955574 DOI: 10.1186/1756-8722-3-34] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 09/28/2010] [Indexed: 11/16/2022] Open
Abstract
Background Mantle cell lymphoma is a lymphoid entity characterized by adenopathy, blood and bone marrow involment which only recurrent mucosal localisation is the lymphomatoid polyposis. Few other mucosal infiltrations have been already reported. Results We report here the first case of a unique tracheal localisation of mantle cell lymphoma at presentation of the disease. The presence of classical t(11;14)(q13;q32) confirmed the diagnosis of mantle cell lymphoma by eliminating MALT or cancer localisation. Conclusion This case illustrates the necessity to ensure the diagnosis of mucosal lymphoma versus MCL since these diseases need different treatment regimens and prognoses.
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Affiliation(s)
- Jean-Christophe Ianotto
- Institut de Cancéro-hématologie, Département d'Hématologie, Hôpital Morvan, CHRU Brest, France.
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Bel Haj Salah M, Ben Brahim E, Zidi YSH, Tangour M, Kilani H, Abdelmoula S, Chatti-Dey S. [Isolated primary gastric localization of a mantle cell lymphoma]. Ann Pathol 2010; 30:321-4. [PMID: 20837246 DOI: 10.1016/j.annpat.2010.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 04/03/2010] [Accepted: 05/28/2010] [Indexed: 11/29/2022]
Abstract
Primary mantle cell lymphoma of the digestive tract is uncommon; it rarely involves the stomach and generally manifests as a lymphomatous polyposis. Isolated gastric localization is exceedingly rare. We present a case of a 57-year-old man who presented with a six-month history of atypical epigastric pain. Endoscopy revealed a large ulceration of the gastric mucosa. Histological examination of the biopsied specimens concluded to a marginal zone B-cell lymphoma (MALT-type) of low-grade. Patient underwent two courses of anti-Helicobacter pylori therapy followed by chemotherapy, without endoscopic amelioration. Histological control showed the persistence of a nodular lymphomatous proliferation that respects glands. It was made of monotonous small cells reactive with CD5 and cyclin D1. The diagnosis of gastric mantle cell lymphoma was made. No other digestive or nodal localization was found. Patient underwent intensive chemotherapy anti-CD20; he was free of disease three years after diagnosis. Primary mantle cell lymphoma of the stomach is an uncommon neoplasm. Diagnosis is often difficult and requires the use of CD5 to exclude a MALT-cell lymphoma, which is much more frequent in this location.
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Affiliation(s)
- Mériam Bel Haj Salah
- Service d'anatomie et de cytologie pathologiques, hôpital M. Tahar Mâamouri, Nabeul, Tunisie.
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Chua SC, Rozalli FI, O'Connor SR. Imaging features of primary extranodal lymphomas. Clin Radiol 2008; 64:574-88. [PMID: 19414080 DOI: 10.1016/j.crad.2008.11.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 10/18/2008] [Accepted: 11/02/2008] [Indexed: 12/14/2022]
Abstract
Lymphomas are generally considered tumours of lymph nodes, but up to 40% arise extranodally. This group shows distinctive pathological, radiological, and clinical features. Different subtypes of extranodal lymphoma may show sufficiently specific radiological features to be of significant value in both establishing a diagnosis of lymphoma and ascertaining the exact subtype. Rapidly evolving lymphoma classifications and emergence of new entities have, however, hampered the accurate description of these features in the literature. In this review, we discuss the radiological appearances, using a variety of imaging methods, of the full spectrum of primary extranodal lymphomas, categorized according to the current World Health Organisation classification.
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Affiliation(s)
- S C Chua
- Department of Nuclear Medicine, PET, and Radiology, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK.
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CNS T-cell lymphoma: an under-recognized entity? Acta Neuropathol 2008; 115:345-56. [PMID: 18196250 DOI: 10.1007/s00401-007-0338-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Revised: 12/20/2007] [Accepted: 12/22/2007] [Indexed: 10/22/2022]
Abstract
The incidence of CNS lymphoma has increased significantly in the past 30 years, primarily in the elderly and immunocompromised. While T-cell lymphomas comprise 15-20% of systemic lymphomas, they comprise less than 4% of primary CNS lymphomas, suggesting that they may be under-recognized compared to their systemic counterparts. To investigate this, we studied brain biopsies from three patients who were diagnosed with T-cell lymphoma confined to the brain. They had enhancing lesions by MRI, arising in the cerebellum and brainstem in one and temporal lobe in two. We compared these to biopsies from three patients who had reactive lymphoid infiltrates and who had clinical signs/symptoms and radiographic findings that were indistinguishable from the lymphoma group. Biopsies from both the lymphoma group and reactive group showed considerable cytomorphologic heterogeneity. Although one lymphoma case contained large atypical cells, the other two contained small, mature lymphocytes within a heterogeneous infiltrate of neoplastic and reactive inflammatory cells. Surface marker aberrancies were present in two lymphoma cases, but this alone could not reliably diagnose T-cell lymphoma. The proliferation index was not useful for differentiating lymphoma from reactive infiltrates. In five of the six cases the diagnosis was most influenced by clonality studies for T-cell receptor-gamma gene rearrangements. We conclude that because of the high degree of overlap in cytomorphologic and immunophenotypic features between T-cell lymphoma and reactive infiltrates, T-cell lymphoma may not be recognized unless studies for T-cell receptor gene rearrangements are performed for CNS lesions composed of a polymorphous but predominantly T-cell infiltrate.
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