Two Cases of Lymphoma of the Oral Cavity
CONCLUSION
Lymphomas are the most common non-epithelial malignant tumors in the oral cavity . 15 The presentation of these tumors is highly variable , and can mimic odontogenic infection , soft tissue swellings , oral ulcerations , and non-healing extraction sockets .
9 , 10 , 15 , 18
These lesions may be painless and asymptomatic .
Case 1 demonstrated a mandibular radiolucency as the initial presentation of this patient ’ s lymphoma . Multiple root canals had previously been performed in the area . However , rather than endodontically retreat these teeth the endodontist referred the patient for biopsy and a definitive diagnosis was quickly made . The patient responded well to therapy . Case 2 is an unusual example of recurrent disease presenting in the oral cavity as an unremarkable periapical radiolucency , impressive palatal soft tissue swelling , and a cutaneous rash . The lesion , failing to respond to endodontic therapy , was promptly referred for biopsy as the palatal swelling was increasing . Although some periapical pathology was present in tandem with the palatal mass and face rash , it was quite subtle .
Although uncommon , hematopoietic neoplasms can occur in the oral cavity , and should be included in the differential diagnosis of multiple oral pathoses , including persistent radiolucencies after adequate root canal therapy , non-healing extraction sockets , unexplained soft tissue swellings , and oral ulceration of unknown origin . Everyday throughout the world routine dental care , including endodontic therapy , extractions , and the application of topical steroids , is performed based on clinical diagnoses . However , when standard dental therapeutics fail , or when the clinical presentation is at an extreme , a biopsy must be performed first to obtain a pathologic diagnosis and to rule out potential malignancies , including lymphoma .
BIBLIOGRAPHY
[ 1 ] Challacombe S . Oral and Maxillofacial Medicine : The Basis of Diagnosis and Treatment . Third Edition . Elsevier ; 2013 .
[ 2 ] Li S . Diffuse large B-cell lymphoma . Pathology . 2018 ; 50 ( 1 ): 74-87 .
[ 3 ] Neville B , Damm D , Allen C , Chi A . Oral and Maxillofacial Pathology . Fourth Edition . St . Louis , Missouri : Elsevier ; 2015 .
[ 7 ] White S , Pharoah M . Oral Radiology : Principles and Interpretation . Fifth Edition . St . Louis , Missouri : Elsevier ; 2013 .
[ 8 ] Woo SB . Oral Pathology : A Comprehensive Atlas and Text . Second Edition . Philadelphia , Pennsylvania : Elsevier ; 2016 .
[ 9 ] Pereira DL . Intraosseous non-hodgkin lymphoma mimicking a periapical lesion . Journal of Endodontics . 2015 ; 41 ( 10 ): 1738-1742 .
[ 10 ] Triantafillidou K . Extranodal non-hodgkin lymphomas of the oral cavity and maxillofacial region : a clinical study of 58 cases and review of the literature . Journal of Oral and Maxillofacial Surgery . 2012 ( 70 ): 2776-2785 .
[ 11 ] Jessri M . A case of primary diffuse large b-cell non-Hodgkin ’ s lymphoma misdiagnosed as chronic periapical periodontitis . Australian Dental Journal . 2013 ; 58 ( 2 ): 250-255 .
[ 12 ] Hunt K . Diffuse large B-cell lymphoma . Archives of Pathology . 2008 ; 132 ( 1 ): 118-24 .
[ 13 ] O ’ Malley D . Practical applications in immunohistochemistry : Evaluation of diffuse large B-cell lymphoma and related large B-cell lymphomas . Archives of Pathology . 2015 ; 139 ( 9 ): 1094-107 .
[ 14 ] Cheson B . Therapy for diffuse large B-cell lymphoma : getting personal . The Lancet . 2013 ; 381 ( 9880 ): 1793-1794 .
[ 15 ] Kolokotronis A . Localized B-cell non-Hodgkin ’ s lymphoma of oral cavity and maxillofacial region : a clinical study . Oral Surgery Oral Medicine Oral Pathology Oral Radiology Endodontology . 2005 ; 99 ( 3 ): 303-310 .
[ 16 ] Santos FPS . Small lymphocytic lymphoma and chronic lymphocytic leukemia : Are they the same disease ? The Cancer Journal . 2012 ; 18 ( 5 ): 396-403 .
[ 17 ] Inamdar K . Pathology of chronic lymphocytic leukemia : an update . Annals of Diagnostic Pathology . 2007 ; 11 ( 5 ): 363-389 .
[ 18 ] Alessandrini M . Unusual case of oral chronic lymphocytic leukemia presenting as recurrent epistaxis and asymptomatic intraoral swelling . Revue de stomatology et de chirugie maxillofaciale . 2012 ; 113 ( 6 ): 455-457 .
[ 19 ] Kipps T . Chronic lymphocytic leukemia . Nature Reviews . 2017 ; 3:16096 .
[ 20 ] Hallek M . Chronic lymphocytic leukemia : 2020 update on diagnosis , risk stratification and treatment . American Journal of Hematology . 2019 ; 94 ( 11 ): 1266-1287 .
[ 21 ] Chastain E . Clinical prognostic biomarkers in chronic lymphocytic leukemia and diffuse large b-cell lymphoma . Archives of Pathology Lab Medicine . 2015 ; 139 ( 5 ): 602-607 .
[ 22 ] Epstein J . Characteristics of oral and paraoral malignant lymphoma : a population based review of 361 cases . Oral Surg Oral Med Oral Pathol Oral Radiol Endo . 2001 ; 92 ( 5 ): 519-25 .
[ 23 ] Richards A . Oral mucosal non-Hodgkin ’ s lymphoma : a dangerous mimic . Oral Oncology . 2000 ; 36 ( 6 ): 556-558 .
[ 24 ] Franciosconi CF . Leukemic oral manifestations and their management . Asian Pacific Journal of Cancer Prevention . 2016 ; 17 ( 3 ): 911-915 .
[ 26 ] Schaedel R . Chronic lymphocytic leukemia of B-cell origin : oral manifestations and dental treatment planning . JADA . 1997 ; 128 ( 2 ): 206-210 .
[ 27 ] Alcure ML . Large infiltration of chronic lymphocytic leukemia in the mandibular region . Oral Oncology Extra . 2006 ; 42:49-51 .
[ 28 ] Peters S . Chronic lymphocytic leukemia in association with a ranula : a report and review of the literature . Oral Surg Oral Med Oral Pathol Oral Radiol . 2017 ; 123 ( 5 ): e160-e163 .
[ 29 ] Jessri M . A case of primary diffuse large B-cell non-Hodgkin ’ s lymphoma misdiagnosed as chronic periapical periodontitis . Australian Dental Journal . 2013 ; 58 ( 2 ): 250-255 .
[ 31 ] Solomides C . Lymphomas of the oral cavity : histology , immunologic type , and incidence of Epstein-barr virus infection . Human Pathology . 2002 ; 33 ( 2 ): 153-157 .
[ 32 ] Bhattacharyya I . Primary diffuse large b-cell lymphoma of the oral cavity : germinal center classification . Head and Neck Pathology . 2010 ; 4 ( 3 ): 181-191 .
[ 33 ] Sehn L . Diffuse large b-cell lymphoma : optimizing outcome in the context of clinical and biologic heterogeneity . Blood . 2015 ; 125 ( 1 ): 22-32 .
[ 34 ] Kolokotronis A . Localized b-cell non-hodgkin ’ s lymphoma of oral cavity and maxillofacial region : a clinical study . Oral Surg Oral Med Oral Pathol Oral Radiol Endo . 2005 ; 99 ( 3 ): 303-310 .
[ 35 ] Owosho A . Large b-cell lymphoma of the base of tongue and oral cavity : a practical approach to identifying prognostically important subtypes . Oral Surg Oral Med Oral Pathol Oral Radiol . 2014 ; 118 ( 3 ): 338-347 .
[ 36 ] Guevara-Canales JO . Malignant lymphoma of the oral cavity and maxillofacial region : overall survival prognostic factors . Med Oral Patol Oral Cir Bucal . 2013 ; 18 ( 4 ) e619-626 .
[ 37 ] Cho-Vega JH . Leukemia cutis . American Journal of Clinical Pathology . 2008 ; 129 ( 1 ): 130-142 .
[ 38 ] Jain N . Approaches to chronic lymphocytic leukemia therapy in the era of new agents : the conundrum of many options . American Society of Clinical Oncology Educational Book . 2018 ; ( 38 ): 580-591 .
JANUARY / FEBRUARY 2022 | PENNSYLVANIA DENTAL JOURNAL 17