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An Official Publication of the Indian Association of Oral and Maxillofacial Pathologists


 
CASE REPORT Table of Contents   
Year : 2005  |  Volume : 9  |  Issue : 1  |  Page : 34-36
 

Maxillary Non-Hodgkins lymphoma


1 Department of Oral Pathology, Saveetha Dental College and Hospital, Chennai, India
2 Department of Oral Surgery, Saveetha Dental College and Hospital, Chennai, India
3 Lecturer in Oral Pathology, Ragas Dental College and Hospital, Chennai, India
4 Professor in Oral Pathology, Ragas Dental College and Hospital, Chennai, India

Correspondence Address:
S Sankaranarayanan
Department of Oral Pathology, Saveetha Dental College and Hospital, Chennai
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-029X.39059

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   Abstract 

Extranodal non-Hodgkins lymphoma of the maxilla could present as one of the early manifestation of detrimental diseases. Clinically these types of lymphoma can mimic an inflammatory endo- periodontal lesion with symptoms of pain and local discomfort. The greater the delay in diagnosis subsequently worsens the prognosis. A case of maxillary non-Hodgkin's lymphoma with an unusual presentation is discussed­


Keywords: Non-hodgkins lymphoma, Maxilla, Oral lesions, Extranodal


How to cite this article:
Sankaranarayanan S, Chandrasekar T, Srinivasa Rao P, Rooban T, Ranganathan K. Maxillary Non-Hodgkins lymphoma. J Oral Maxillofac Pathol 2005;9:34-6

How to cite this URL:
Sankaranarayanan S, Chandrasekar T, Srinivasa Rao P, Rooban T, Ranganathan K. Maxillary Non-Hodgkins lymphoma. J Oral Maxillofac Pathol [serial online] 2005 [cited 2019 Nov 16];9:34-6. Available from: http://www.jomfp.in/text.asp?2005/9/1/34/39059



   Introduction Top


Dental surgeons commonly encounter swellings, which could be developmental, inflammatory, or neoplastic in origin. Although neoplastic tumors constitute only a minority of such conditions, a dentist must he aware of the various tumors that could mimic an ordinary swelling. A systematic approach including detailed clinical history, proper clinical examination, and use of laboratory investigation would enable the dental surgeon to point out the differential diagnosis of such lesions. Further appropriate histopathological studies would help in arriving at a proper clinical diagnosis.

Primary tumors of jawbones are by themselves a rare entity. Malignant lymphomas constitute a group of neoplastic, proliferative process of the lymphocytes and / or histiocytes in any of their developmental stages. A complete medical workshop is essential to ascertain in their diagnosis and staging. This case report describes such a case of primary non-Hodgkins lymphoma involving facial structures.


   Case Report Top


A 46-year-old male patient reported to the department of Oral surgery, Saveetha Dental College and Hospital with a complaint of a swelling on the right side of the face since 1½, years. The swelling was seen on the maxilla near the malar arch. It started as a small swelling and has attained the present size 1 year back when it was biopsied and reported as a lymph node with adipose tissues. The healing after incisional biopsy was uneventful. The past medical history was non­contributory except that there was a similar swelling in the left side of face that was surgically removed. On examination, the swelling was 4 x 5 sq. cm, in size extending 2 cm away from the right alae of the nose, anteriorly and 1 cm away from the right ear posteriorly. Superiorly, it extended on to the right malar arch and inferiorly, a cm away from the right commissure of the mouth. On extra oral examination, palpation revealed a diffuse swelling that was non tender and firm on palpation. The swelling was not fixed to underlying structures and skin over the swelling was normal and freely rnovable. It appeared slightly stretched but was not erythematous or edematous [Figure - 1]. The lymph nodes were not palpable. On intraoral examination, there was a swelling present in the buccal rnucosa opposite to the upper right permanent molars and retromolar area. A provisional diagnosis of facial lymphadenitis was arrived at and the lesion was excised under local anesthesia using blunt dissection and submitted for histopathological studies [Figure - 2].

Histopathology

The haematoxylin and eosin stained soft tissue section showed fibrous connective tissue, skeletal muscle fibers, and sheets of small lymphoid cells with small round nuclei, clumped chromatin, and scanty cytoplasm [Figure - 3], 10x. Occasional large cells with vesicular nuclei and prominent nucleoli were also seen [Figure - 4], 20x. Immunohistochemistry showed predominantly CD 20 positive B cells with a MIB 1 proliferation index of 10%. Occasional CD3 positive T cells were seen. These results were suggestive of low-grade non Hodgkins lymphoma.


   Discussion Top


lymphoma is second only to squamous cell carcinoma in the frequency of malignant neoplasia involving the soil tissues of head and neck region, which usually affects the lymph nodes. Non-Hodgkins lymphomas are a group of highly diverse malignancies and have great tendency to affect organs and tissues that do not ordinarily contain lymphoid cells. 20-30%) of non-Hodgkins lymphomas arise from extra-nodal sites.

The head and neck is the second most common region for the extra-nodal lymphoma, the first being gastro­intestinal tract. Among various head and neck sites, Waldeyers ring, which is the area encompassed by the nasopharynx, tonsil, and base of the tongue, is the most often involved by malignant lymphoma. The nose para­nasal sinuses, orbit(s), and salivary glands are the other sites affected in head and neck region. Involvement of the oral cavity is not common. The maxilla is affected more commonly than the mandible. Eisenbud [4] and Slootweg [5] found 70% of lesions in maxilla, the most common site being the palate and gingiva. Freeman [2] estimates that intra-oral presentations represent 2.6% of all extra nodular NHL and Fukuda [3] quotes a figure of 5%.

Only 26 cases of the non-Hodgkins lymphoma of the check have been mentioned in English literature. The incidence of the carcinoma involving the buccal mucosa or check is very high but non-Hodgkins lymphoma of buccal mucosa is rare. There has been only one report of NHL occurring in check from India [1] . The present case is an addition to such report.

NHL usually affects adults between the ages of 40-80 years [6] . There is reversal of the incidence of NHL among young HIV positive patients [7] . HIV patients are 60 times at risk than the general population and around 3% of HIV infected people develop lymphomas [7] .

There are no characteristic clinical features of lymphoma of the oral region. The presenting signs and symptoms are secondary to the lesion. They occur as local bone swelling, tooth mobility, painless inflammation of the mucosa with or without ulcerations, and rarely facial or dental pain. Additional observations include trismus, otalgia, gingival ulceration, sinusitis, or cervical lymphadenopathy. The oral NHL can mite is the more common benign oral and dental pathological conditions [5] . In our case, the patient was aware of the slow growing swelling that was not painful and the skin over the area was normal. Specific and evident radiological signs of bone involvement may be absent in 10-20% of cases. The radiographic findings usually are those of periapical inflammatory processes or osteitis. Diffuse trabecular honeycomb and or dental rhizolytic images are occasionally observed. Those may be the images of cortical destruction and invasion of the maxillary sinus. Differential diagnosis includes infectious process such as systemic or deep mycosis, dento-alveolar abscess, dental infections; neoplastic process, wherein very rapid growth is a feature of sarcomas and lympho­proliferative disorders, Wegener's granulomas, and midline lethal granulomas most commonly squamous cell carcinomas and benign tumors like fibromas and lipoma; metastatic tumors.


   Conclusion Top


In conclusion, though the NHL involving the oral region is uncommon, it should always he considered in the differential diagnosis of benign and malignant lesions in this region, because the treatment and prognosis of these conditions is quite different. Even though a dentist does not treat malignant lymphomas, he/ she may be the first to diagnose the lesion. Thus dental surgeons indirectly form a part of the team that treats lymphomas. Morever, a thorough understanding of the disease process will enable the dental surgeon to treat the complications of the disease or its treatment such as candidiasis, mucositis, xerostomia, adverse drug reactions, and osteoradionecrosis.

 
   References Top

1.Maheshwari GK, Baboo HA, Gopal U, Wadhwa MK. Primary extra-nodal non-h­odgkins lymphoma of the cheek. Images in Medicine; 2000:46(3),211-2,  Back to cited text no. 1    
2.Freeman C, Berg .JW, Cutler SJ. Occurrence on prognosis of extranodal lymphoma. Cancer 1972: 29: 252-60.  Back to cited text no. 2    
3.Fukuda Y, Ishida T. Fujimotto M, Veda T, Aocasa K. Malignant lymphoma of the oral cavity: clinicopathologic analysis of 20 cases. J Maxillo Fac Surg 1985; 13: 85-92.  Back to cited text no. 3    
4.Eisenbud L, Scinbba J. Mir Rabia, Sachs SA. Oral presentations in non Hodgkins Vs lymphoma: A review of thirty-one cases. Part I. Data analysis. Oral Surg, Oral Med, Oral Pathol 1984: 57:272-80  Back to cited text no. 4    
5.Slootweg PJ, Wittkampf ARM, Kluin PM, de Wilde PCM Van Unnik JAM. Extranodal nodal non- Hodgkin Vs lymphoma of the oral tissues. An analysis of 20 cases. J Maxillo Fac Surg 1985; 13: 85-92.  Back to cited text no. 5    
6.Landa Liona S, P' erez- Nievas Borderas I, Montes Garcia E, Ereno Zarate C, Pereda Marinez E. Barbier Herrero L, Garaizar Zorilla, Santamaria Suazua J. Maxillary non hodgkins lymphoma. A report of two clinical cases and review of the literature. Med Oral 1998; 3:299-308.  Back to cited text no. 6    
7.John Hicks M, Catherine M Flaitz, Mark Nicholas C. Mario A Luna, Vicky Gresik M. Intraoral presentation of anaplastic large cell Ki-1 lymphoma in association with HIV infection. Oral Surg, Oral Med, Oral Pathol 1993: 76.73-81  Back to cited text no. 7    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]



 

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    Abstract
    Introduction
    Case Report
    Discussion
    Conclusion
    References
    Article Figures

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