Primary extranodal lymphoma of the maxilla: a case report with imaging features and dynamic data analysis of magnetic resonance imaging

Malignant lymphoma is the second-most common malignancy in the head and neck region. Waldeyer's ring is the most common site of extranodal Hodgkin's lymphoma (NHL) in that region, and a small percentage of primary extranodal NHL occurs in the oral cavity. The most common sites of extranodal NHL in the oral region are the palate and maxilla, and nearly half of extranodal NHL cases arise from bone. It is difficult to diagnose extranodal NHL because of the variety of its radiological features. We report a case of primary extranodal NHL of the maxilla in a 68-year-old female patient with atypical imaging findings, along with the results of analysis of dynamic magnetic resonance imaging (MRI).     

Treatment of non-Hodgkin's lymphoma of waldeyer's ring: Radiotherapy versus chemotherapy versus combined therapy

Treatment of stage IA non-Hodgkin's lymphoma (NHL) of Waldeyer's ring remains controversial, probably because of the small number of patients and the scarcity of controlled studies. Between 1981 and 1991, 316 patients with stage I NHL of Waldeyer's ring were randomised for treatment with radiotherapy alone (extended fields), 101 patients; combined chemotherapy with a regimen of CHOP (cyclophosphamide, vincristine, doxorubicin, and prednisone) or CHOP-like (epirubicin instead of doxorubicin), 106 patients; and combined therapy (radiotherapy followed by the same combination chemotherapy), 109 patients. Median follow-up was 6.8 years. Complete response was achieved in 93, 87 and 97%, respectively. Relapses were least frequent in patients treated with combination therapy. The 5-year rate for failure-free survival was 48% for radiation therapy, 45% for the patients who were treated with chemotherapy, which was statistically significantly less than the 83% for patients treated with combined therapy (P < 0.001). Overall survival was also better in the combined therapy arm: 90%, statistically different to 58% for the patients treated with chemotherapy alone and 56% for patients treated with radiation therapy (P < 0.001). Toxicity was mild and late side-effects were not observed in any patients. From these results combined therapy should be considered as the best therapeutic approach in patients with localised NHL of Waldeyer's ring.     

Orofacial non-Hodgkins lymphoma in Nigerians.

PURPOSE: In this study, we sought to determine the occurrence of primary non-Hodgkins lymphoma (NHL) in the oral and maxillofacial region among Nigerians. PATIENTS AND METHODS: We retrospectively studied hospital records that included radiographs of all patients with a histopathologically confirmed diagnosis of NHL in the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria, between January 1992 and December 1997. Data were expressed as mean +/- SD or number (%). RESULTS: During the study period, 66 cases of NHL were recorded. Seventeen patients had concomitant extranodal lymphomas involving the gastrointestinal tract, nasopharynx, skin, lungs, kidney, and thyroid, in descending order. Three patients (4.5%) presented primarily with extranodal oral and maxillofacial disease. The ages of these patients ranged from 18 to 50 years (mean +/- SD, 32.3 +/- 16.3 years; median, 29 years). Within the same period, there were 121 cases of Burkitts lymphoma. The onset of lesions varied from 6 to 20 weeks. Two patients had intermediate-grade lesions; the remainder had low-grade lesions. Two presented with stage II disease, and the remainder were stage I. All of the patients had chemotherapy with remission of their lesions but were followed up to 6 months. Most of them did not complete the treatment cycles due to financial and social constraints. CONCLUSIONS: The rarity of primary NHL of oral and maxillofacial region has been aptly shown in this study. The need for the establishment of an effective oncology policy with the active collaboration of voluntary agencies is emphasized. This would ensure ready availability of the required chemotherapeutic agents and hospital care at affordable costs.     

Oral manifestations of non-Hodgkin's lymphoma in HIV-infected patients

The incidence of non-Hodgkin's lymphomas (NHL) in patients infected with human immunodeficiency virus (HIV) is relatively high. However, there have been few reports on the clinical and histopathological features of oral manifestations of NHL in these patients. The lesions reported so far were all tumorous swellings with or without ulceration, as in non-HIV-infected patients. In this report 3 cases are presented of HIV-infected patients with solitary, primary oral NHL. These lesions showed a striking resemblance to acute, necrotizing gingivitis, a common finding in these patients, thus making the diagnosis more difficult.     

Primary non-Hodgkin's lymphoma of the mandible treated with radiotherapy, chemotherapy, and autologous peripheral blood stem cell transplantation

Extranodal presentation in non-Hodgkin's lymphoma (NHL) is uncommon, and the mandible is very rarely involved. Primary NHL of the mandible, for the most part, has intermediate or high malignancy and has a much greater incidence of local recurrence compared with other sites of involvement. A 48-year-old Japanese man with NHL of the mandible received radiotherapy, followed by high-dose chemotherapy supported with peripheral blood stem cell transplantation (PBSCT). High-dose cyclophosphamide, Adriamycin, and vincristine were used for pretransplant conditioning. He achieved complete remission and has survived in continuous complete remission for more than 72 months to date. Marrow-ablative chemotherapy facilitated by PBSCT is thought to be useful as part of the primary therapy for patients with NHL who have poorer prognoses.     

Head and neck non-Hodgkin's lymphoma: a 20-year demographic study of 381 cases

Malignant lymphoma is a lymphoreticular malignancy with considerable geographic variation. The objective of the present study was to provide a preliminary report on patients with head and neck non-Hodgkin's lymphoma (NHL) in a selected Iranian population. In a retrospective review from 1981 through 2001, all cases of NHL occurring in the head and neck region were selected. Histological slides were reviewed and classified according to the Working Formulation. Clinical data including patients’ age, sex, initial anatomic site of disease and presenting symptoms were also recorded. Information on 381 cases of NHL was retrieved from the archived medical records; 281 cases were nodal and 100 extranodal. The mean age of the patients with nodal and extranodal disease was 39.3 and 47.7 years, respectively. A significant difference in gender was noted in the nodal group (P < 0.001), but not in the extranodal cases. The most common site of involvement in the extranodal subjects was Waldayer's ring. According to histopathologic evaluation, 72% of the specimens were intermediate-, 14% were high-, and 12% were low-grade malignancies. Considering the relative frequency of head and neck lymphoma, establishment of a uniform reporting method seems necessary in order to compare different reports from various populations.     

头颈部非霍厅金淋巴瘤的CT表现

目的 评价头颈部非霍奇金淋巴瘤（ｎｏｎ－Ｈｏｄｇｋｉｎ ｌｙｍｐｈｏｍａ,ＮＨＬ）的ＣＴ表现特点,为临床诊疗提供可靠依据。方法 将３６例ＮＨＬ病灶分为颈淋巴结内线和淋巴结外组,并观察其ＣＴ形态、密度和边缘。结果 结外ＨＮＬ病 变共３９灶（３１例）,依次风于Ｗａｌｄｅｙｅｒ环（１１灶）、上颌８灶）、颌面间隙（７灶）、肋腺（６灶）和头颈其他部（７灶）。病变形态有肿块和粘膜异常增厚之分。结内ＮＨＬ病变共     

Primary and exclusive gingival localization of non-Hodgkin lymphomas. Case report

A case of primary and exclusive gingival localization of a non-Hodgkin lymphoma (NHL) personally observed at the Surgical Out-patients Unit of the Department of Dentistry at the Umberto I Hospital in Rome, is described. A 71 year-old caucasian male was referred by his private dentist because of a severe pain at the soft tissue of the mandible even after dental, neurologic and parodontal treatments. At clinical examination, a severe gingival swelling in the symphysis region with hard bleeding, palpable lymph nodes and no important evidence in radiographic and CT examinations were found. After incisional biopsy and its examination, a diagnosis of NHL was made. Further examinations did not show metastasis dissemination. The patient was referred to the Hematology Department and after 4 chemotherapy cycles over 12 months, he completely recovered. After an introduction on NHL, the clinical case is described as well as how to make a correct diagnosis; moreover, the importance of the dentist in identifying diseases even not strictly related to oral cavity but whose signs and manifestations appear over there, is stressed.     

头颈部非霍奇金淋巴瘤的CT表现

目的　评价头颈部非霍奇金淋巴瘤(nonHodgkinlymphoma,NHL)的CT表现特点,为临床诊疗提供可靠依据。方法　将36例NHL病灶分为颈淋巴结内组和淋巴结外组,并观察其CT形态、密度和边缘。结果　结外NHL病变共39灶(31例),依次见于Waldeyer环(11灶)、上颌(8灶)、颌面间隙(7灶)、腮腺(6灶)和头颈其他部(7灶)。病变形态有肿块和粘膜异常增厚之分。结内NHL病变共累及16侧颈区淋巴结。结外NHL伴结内NHL者共10侧颈区。结论　头颈部结外NHL的CT表现特点为多发边缘不光滑的软组织实性肿块;颈淋巴结内NHL多有坏死和边缘增强,淋巴结融合肿块则于单发结内NHL中多见     

Malignant lymphoma of the mucosa-associated lymphoid tissue (MALT) – consecutive unusual manifestation in the rectum and gingiva

Non-Hodgkin's lymphomas (NHL) of the mucosa-associated lymphoid tissue (MALT) are characterized by a preferential mucosal manifestation. Each organ system may be involved. Exclusively local growth is usually treated with surgical tumour reduction, combined with radiotherapy. In cases of tumour dissemination, chemotherapy is warranted. Follow-up should be performed closely. This case report highlights an unexpected recurrence of NHL in the oral MALT, four years after primary manifestation in the rectum.     

Non-Hodgkin's lymphoma of the tongue: a case report

Oral manifestations are present in about 3–5% of cases of non-Hodgkin's lymphoma (NHL) and oral lesions are only rarely the initial manifestations of NHL. A case is presented of an 80-year-old patient with a NHL of the tongue, without visceral or lymph node involvement. The diagnosis of NHL can be made only by biopsy. The prognosis of NHL seems to be related to the tumour stage, tumour aggressiveness and response to treatment: the oral lesions appear to respond quite well to irradiation.     

Long-term effects of chemotherapy on orodental structures in children with non-Hodgkin's lymphoma

The aim of this study was to investigate the late effects of treatment for childhood non-Hodgkin's lymphomas (NHL) on oral health and dental development. Thirty-six long-term survivors that had been treated with chemotherapy of childhood NHL were included in this study and 36 volunteers with similar age and sex distribution served as controls. Both groups underwent a complete orodental examination for decayed, missing and filled teeth and surfaces, gingival and periodontal health according to the Loe-Silness Gingival Index and Sillnes-Loe Plaque Index, enamel defects and discolorations, root malformations, eruption status, agenesis, premature apexifications and microdontia. The severity of these disturbances related to age at the time of NHL diagnosis were also evaluated by creating two groups as < 5 yr and > 5 yr. Although none of the parameters altered with age, patients had significantly higher plaque index, more enamel discolorations and root malformations than did the controls. The results show that long-term survivors of NHL patients exhibit some orodental disturbances that may be attributed to the chemotherapy regimens.     

AIDS-related lymphoma of the oral cavity

Six new cases of non-Hodgkin's lymphoma (NHL), primarily located in the oral cavity, in patients infected by the human immunodeficiency virus (HIV), are presented. They all had a voluminous fungous tumoral mass, that extended from the gingiva to the buccal vestibule or palate. All were intravenous drug abusers. The diagnosis of AIDS was known in one patient, 2 patients presented with AIDS-related complex symptomatology, and in 3 cases NHL was the first manifestation of the HIV infection. All presented advanced stages (IV). Histologically, all were considered high grade NHL. It is recommended to determine the HIV status in all young patients affected with oral NHL. All intraoral lesions in AIDS patients or in patients that belong to a risk group should have a biopsy to rule out NHL or any other manifestations of AIDS.     

口腔颌面部非何杰金氏淋巴瘤流式细胞DNA分析及意义探讨

目的:探讨流式细胞学各项指标与非何杰金氏淋巴瘤(NHL)发病部位、临床分期、病理分级、细胞类型及预后的关系和流式细胞学对NHL的诊断价值。方法:采用流式细胞仪测定50例口腔颌面部NHL及10例反应性增生淋巴结(RLN)石蜡包埋组织的DNA倍体、细胞周期各参数,并分析各参数及其与预后的关系。结果:10例RLN皆为二倍体,而NHL二倍体率为54%,异倍体率为46%,二者有显著性差异。SPF值、S+G2/M值与非何杰金氏淋巴瘤恶性程度密切相关,SPF值、S+G2/M值随肿瘤的恶性程度增大而增大。结论:口腔颌面部淋巴瘤流式细胞学检测具有一定诊断学价值,但其运用一定要与形态学相结合。同时SPF、S+G2/M等指标可以反映其细胞增殖状况及病理学恶性程度。     

口腔颌面部结外型非霍奇金淋巴瘤临床研究

目的:探讨原发于口腔颌面部结外型非霍奇金淋巴瘤的多样性及其鉴别诊断。方法:回顾性分析1999.3-2006.10收住我科的15例颌面部结外型非霍奇金淋巴瘤的临床资料。结果:15例颌面部结外型非霍奇金淋巴瘤临床表现多样性,首诊易发生误诊。结论:原发于颌面部的非霍奇金淋巴瘤临床表现多样性需与其他疾病相鉴别,以减少误诊;确诊需依靠病理学诊断。治疗上以CHOP及改良CHOP方案化疗为主。     

Primary non-Hodgkin's lymphoma of the jaws: immunohistochemical and genetic review of 10 cases.

PURPOSE: Non-Hodgkin's lymphoma (NHL) comprises a group of malignant lymphoproliferative diseases characterized by clonal expansion of lymphocytes at various levels of ontogenetic development. The aim of this study was to review the immunohistochemical and cytogenetic features of 10 cases of NLH of the jaws to determine their respective derivation. PATIENTS AND METHODS: Histopathologic and immunohistochemical review of 10 cases of large-cell lymphomas of the jaws, together with Southern blot analysis of 2 of the cases, was performed and results compared with the findings in the literature. RESULTS: In the 10 cases studied, the average age of onset of the NHL was 51 years, with a male-to-female ratio of 3:2. Tumefaction was the first clinical sign of disease. Eight of 10 cases were high-grade, large-cell NHLs, centroblastic type. Two cases were high-grade, large-cell NHL, immunoblastic type. CONCLUSION: The immunohistochemical and Southern blot data remain the principal laboratory aids in the diagnosis and characterization of NHL, and they provide critical information for guiding clinicians to the appropriate treatment protocol for these malignancies.     

Maxillary and Mandibular Non-Hodgkin Lymphoma with Concurrent Periapical Endodontic Disease: Diagnosis and Management

Extranodal non-Hodgkin lymphoma (NHL) in the oral region can present similarly to diseases of odontogenic origin. The objective of this report was to describe a rare case of maxillary and mandibular NHL that presented similarly to and concurrently with lesions of odontogenic origin.A unique case of extranodal NHL, which presented at the apices of maxillary and mandibular teeth in conjunction with lesions of odontogenic origin in a 68-year-old white man, is described. The patient sought care because of a lesion in the right maxillary paranasal region that caused him paresthesia. Radiographically, periapical radiolucencies were present along teeth #5-8, #23 and 24, and #30 and 31. Biopsies of the right maxillary and anterior mandibular lesions were completed and led to a diagnosis of NHL at the apices of teeth #5-8 extending to the hard palate and granulation tissue at the apices of teeth #23 and 24. Two years later, the patient returned because of pressure and sensitivity associated with teeth #30 and 31. Vestibular swelling was noted clinically, and a multilocular periapical radiolucency was present radiographically. Via endodontic therapy and a positron emission tomographic scan, the lesion associated with teeth #30 and 31 was determined to be of both odontogenic and nonodontogenic origin because it possessed both a sinus tract associated with tooth #30 and NHL. Lesions of odontogenic and nonodontogenic origin possess diagnostic and treatment challenges because they may present similarly and/or concurrently. Thoughtful and conservative management of odontogenic lesions with associated NHL is imperative. Interprofessional collaboration and communication among providers must be thorough and clear to properly coordinate care and prevent delays in diagnosis and treatment when these entities occur together.     

Etiology of AIDS-related Kaposi's sarcoma and lymphoma

Kaposi's sarcoma (KS) and non-Hodgkin's lymphomas (NHL) are common consequences of HIV infection. These tumours appear to be precipitated by herpesviruses. Epstein-Barr virus (EBV) is implicated as a cause of up to 50% of systemic NHLs and up to 100% of central nervous system lymphomas in patients with AIDS. KS may be a consequence of the newly identified gamma-herpesvirus KSHV (KS-associated herpesvirus or HHV-8). This herpesvirus is found in all KS biopsies from different epidemiologic forms of this disease. KSHV is also implicated in the pathogenesis of a rare form of B cell lymphoma called body-cavity based lymphoma or primary effusion lymphoma (PEL).     

口腔颌面部非霍奇金淋巴瘤临床病理分析

目的:探讨与口腔颌面部非霍奇金淋巴瘤确诊相关的临床病理特点。方法:对2000-02—2012-03郑州大学附属洛阳市中心医院口腔颌面外科收治的17例非霍奇金淋巴瘤,进行回顾性临床病理分析。结果:口腔颌面部非霍奇金淋巴瘤可发生于任何年龄,男女之比为2.4∶1,可发生于颈部及颌下区、牙龈、腭部、腮腺、颊部及舌根部等。病理类型以B细胞淋巴瘤多见。临床及病理首诊确诊率均偏低。结论:口腔颌面部非霍奇金淋巴瘤临床表现多样,确诊依靠病理学诊断,但对取检标本及病理诊断均有较高要求,有些不典型病例需进行分子生物学检测及严密随访。