あご・口くう領域に初発症状を呈した悪性リンパしゅの２例

Abstract

Malignant lymphoma is a neoplasm of lymphoid tissue. Although its favorite site is the head and neck, it occurs, though rarely, in the oral and maxillofacial regionas well.A biopsy of tumor of the head and neck is a principal clue for diagnosis of malignant lymphoma. Once a biopsy diagnosis for malignancy has been established, it is important to undertake a search for all sites of involvement, using a combination of clinical, roentgenographic, laboratory and surgical techniques. After treatment has begun, clinicians should be conscious of patterns of response to treatment, acute morbidity associated with radiotherapy and chemotherapy, and major complications that may result from these forms of treatment.This report includes two cases of malignant lymphoma in the oral and maxillofacial region.Case 1: A 39-year-old woman complained of ulceration on the left buccal gingiva of the molar teeth, and noticed paresthesia of the left lower lip. Enlargement of the lymphnodes of the submandibular, cervical, axillary and inguinal regions could not be detected. Biopsy of the region of ulcer, the cervical vaginal portion and the bone marrow, and other examinations established the diagnosis for non-Hodgkin's lymphoma, diffuse lymphoma, mixed type, stage IV B. Though treated effectively with CHOP, she died of shock two months after appearance of the first symptoms.Case 2: A 77-year-old woman noticed three months prior to the first visit that her left submandibular region had swollen without pain. This lesion was about 7×4 cm and immobile, and suspected to be a tumor of the submandibular salivary gland. Biopsy and other examinations were performed which showed non-Hodgkin's lymphoma, diffuse lymphoma, medium cell type, stage I A. She was treated with chemotherapy (COPP) and radiotherapy (total dose 50 Gy) to the upper part of the left side of the neck. After the treatment, suprahyoid neck dissection was performed. Histopathologically, no evidence of malignancy was found. The postoperative course was uneventful, and there has been no sign of recurrence of the tumor or of metastasis to other organs since discharge.