Journal of Oral and Maxillofacial Pathology

SHORT COMMUNICATION
Year
: 2008  |  Volume : 12  |  Issue : 2  |  Page : 85--87

Non-Hodgkin's lymphoma of the hard palate


R Jayakrishnan1, Gigi Thomas1, Aswin Kumar2, Rekha Nair3,  
1 Division of Community Oncology, Regional Cancer Centre, Thiruranthapuram, Kerala, India
2 Divisions of Radiotherapy, Regional Cancer Centre, Thiruranthapuram, Kerala, India
3 Divisions of Cytopathology, Regional Cancer Centre, Thiruranthapuram, Kerala, India

Correspondence Address:
R Jayakrishnan
Division of Community Oncology, Regional Cancer Centre, Medical College Post, Thiruvanantapur, 695 011, Kerala
India

Abstract

Background: Non-Hodgkin«SQ»s lymphoma usually involves lymph nodes but can also involve extranodal sites. Oral lymphomas are relatively rare and often difficult to diagnose in a clinical setting. We present a case of a patient of non-Hodgkin«SQ»s lymphoma of the hard palate who had undergone external beam radiation therapy and was found to be well 1 year following treatment. Case presentation: A 43-year-old male attended the Community Oncology Division of Regional Cancer Centre with complaints of painless swelling on the right side of face of three months«SQ» duration. A computed tomography (CT) scan confirmed irregular destruction of the hard palate towards the right side of the midline with adjacent soft tissue component. Histopathology report confirmed the diagnosis of follicular lymphoma. He was given radical external beam radiation therapy (40 Gy in 20 fractions over 4 weeks). Clinical examination at the end of radiation revealed complete disappearance of the palatal swelling. Conclusion: Oral lymphomas are relatively rare and often difficult to diagnose as the clinical features mimic other pathological entities such as periodontal disease, osteomyelitis, and other malignancies. A careful clinical evaluation supported by radiologic and histopathologic investigations will help in identifying the disease at an early stage, which will result in better prognosis.



How to cite this article:
Jayakrishnan R, Thomas G, Kumar A, Nair R. Non-Hodgkin's lymphoma of the hard palate.J Oral Maxillofac Pathol 2008;12:85-87


How to cite this URL:
Jayakrishnan R, Thomas G, Kumar A, Nair R. Non-Hodgkin's lymphoma of the hard palate. J Oral Maxillofac Pathol [serial online] 2008 [cited 2018 Oct 21 ];12:85-87
Available from: http://www.jomfp.in/text.asp?2008/12/2/85/44586


Full Text

 Introduction



Malignant lymphoma is the generic term given to tumors of the lymphoid system. Lymph nodes, spleen, and sometimes, non-hemopoetic tissues are involved. These tumors are divided into two major categories: Hodgkin's lymphoma and non-Hodgkin's lymphoma (NHL). Non-Hodgkin's lymphoma is a heterogeneous group of malignancies characterized by an abnormal clonal proliferation of T cells, B cells, or both. The majority of the adult non-Hodgkin's lymphomas are of B cell origin. [1]

NHL is a group of disease entity with a complex histopathological classification that has changed frequently over the years. The clinically useful and convenient Working Formulation subdivides NHL into groups based on biological behavior. Accordingly, tumors are classified into the following groups: low-, intermediate-, and high-grade tumors. [2]

NHL is a disease mainly of the older adult. One third of NHL may present in extranodal sites, presumably arising from lymphoid tissue widely dispersed throughout the body. [3] Oral lymphomas are relatively rare and often difficult to diagnose as the clinical features mimic other pathologies such as periodontal disease, osteomyelitis, and other malignancies. [4]

 Case Report



A 43-year-old man presented to the Division of Community Oncology, Regional Cancer Centre (RCC), Trivandrum, with complaints of painless swelling on the right side of face of three months' duration.

Examination

On inspection, he had a smooth, diffuse swelling of size 4.5×3 cm on the right side of the face, extending from the ala of the nose involving the malar region to the angle of the mandible. There was no lifting of the right ear lobe. The swelling was firm and nontender. Intraoral examination revealed a 3.5×2-cm [Figure 1] firm swelling on the right side of the hard palate extending from the 11 to 16 region (right maxillary central incisor to first molar region) with an intact overlying mucosa and no associated sinus or discharge. The patient had generalized periodontitis with grade 3 furcation involvement. The general clinical examination was otherwise unremarkable.

Investigations

Occlusal radiograph showed diffuse radiolucency extending from the 11 (right maxillary central incisor) to 16 (right maxillary first molar) region. A paranasal view showed diffuse radiolucency on the right side of the hard palate. A computed tomography (CT) scan confirmed irregular destruction of the hard palate towards the right side of the midline with adjacent soft tissue component [Figure 2] and [Figure 3]. Minimal mucosal thickening was noted in the adjacent floor of the right maxillary antrum. An irregular hyperdense area with air-fluid suggestive of inflammatory sinus pathology was discerned in the left maxillary antrum. The hemogram and biochemical profile were within normal limits. Bone marrow examination did not reveal evidence of infiltration.

Pathology

The patient underwent a punch biopsy from the palatal swelling. The presence of mature lymphocytes separated by fibrous septae was viewed on microscopic examination, and a repeat biopsy was suggested. A second incision biopsy was undertaken from the swelling to confirm the diagnosis. The results showed fragments of neoplasm with small-cleaved lymphoid cells arranged in follicular pattern [Figure 4] and with few follicles showing admixed centroblasts [Figure 5]. A diagnosis of follicular lymphoma stage 1AE (low grade under the Working Formulation) was made.

Management

He was referred to the Division of Radiation Oncology, where he underwent radical external beam radiation therapy (40 Gy in 20 fractions over four weeks). Clinical examination at the end of radiation revealed complete disappearance of the palatal swelling after two months [Figure 6].

Follow-up

He continues to be well on subsequent follow-up, one year following treatment.

 Conclusion



The clinical features of oral lymphomas mimic other pathological entities of the oral cavity and are often misdiagnosed as benign dental conditions such as dento-alveolar abscess, periodontal abscess, infected dental cyst, or benign jaw tumors. However, the possibility of malignancies occurring in the hard palate should also be considered. A careful clinical evaluation supported by histopathological and radiologic investigations will help in identifying the disease at an early stage, resulting in better prognosis.

References

1Evans LS, Hancock BW - Non-Hodgkin Lymphoma. Lancet 2003;362:139-46.
2NCI sponsored study of classification of non-Hodgkin's lymphomas: Summary and description of a working formulation for clinical usage. The Non-Hodgkin's Lymphoma Pathological Classification Project. Cancer 1991;49:2112-35.
3Danish LYFO Study Group. Clinicopathological features and prognostic factors in extranodal non-Hodgkin lymphomas. Eur J Cancer 1991;27:1201-8.
4Richards A, Castelloe MA, Everson JW, Scully C, Irvine GH, Rooney N. Oral mucosal non-Hodgkin's lymphoma: A dangerous mimic. Oral Oncol 2000;36:556-8.