Abstract
BackgroundDiffuse large B-cell lymphoma (DLBCL) is the most common type of lymphatic tumor; however, extranodal DLBCLs that exhibit initial symptoms in the maxilla and mandible are rare. Moreover, DLBCL is clinically classified as a moderate to highly malignant lymphatic tumor that can progress rapidly; therefore, early diagnosis is crucial. However, diagnosis is difficult as the disease causes a diverse range of clinical symptoms with no characteristic imaging findings. We conducted a clinical investigation to clarify the clinical characteristics of DLBCL that exhibits initial manifestation in the maxilla and mandible.MethodsOf the 2748 patients with malignant tumors of the oral and maxillofacial region examined at our hospital during a period of 11 years between January 2006 and December 2016, 27 primary cases diagnosed with DLBCL based on the chief complaint of symptoms in the gingiva and bone of the maxilla and mandible were enrolled in this study. Evaluations were based on sex, age, whether treatment was provided by a previous physician, symptoms, duration of disease until treatment was sought, clinical diagnosis, laboratory findings, and imaging results.ResultsThere were 15 cases that involved the maxilla and 12 that involved the mandible. The median duration of disease until treatment was sought was 60 d (3–450 d). All cases exhibited a tumor or a mass, and hypoesthesia of the chin was confirmed in eight cases wherein the mandible was involved. The clinical stages were stage I in eight cases, stage II in ten cases, and stage IV in nine cases. Serum lactate dehydrogenase (LDH) levels were elevated in 13 of 22 patients. The overall survival rate was 63%.ConclusionsSymptoms associated with nontender swelling and numbness of the lip or chin in the absence of other findings such as dental infections should raise suspicions about DLBCL. Patients should be provided appropriate imaging and accurate biopsy assessments to improve prognosis.
Highlights
Diffuse large B-cell lymphoma (DLBCL) is the most common type of lymphatic tumor; extran‐ odal DLBCLs that exhibit initial symptoms in the maxilla and mandible are rare
Tooth extraction had been performed for six cases, resections for four cases, root canal treatment for three cases, and surgical treatment based on another diagnosis for two cases
Of the 2748 cases of malignant tumors of the mouth and jaws examined at our hospital during the 11 years from January 2006 through December 2016, 27 primary cases definitively diagnosed with DLBCL based on the chief complaint of symptoms in the gingiva and bone of the maxilla and mandible were enrolled in this study
Summary
Diffuse large B-cell lymphoma (DLBCL) is the most common type of lymphatic tumor; extran‐ odal DLBCLs that exhibit initial symptoms in the maxilla and mandible are rare. Extranodal DLBCLs in the maxilla and mandible are rare, and differential diagnosis is difficult as they often exhibit clinical findings similar to that found in tumors and/or inflammation at other sites. Some reports have described the clinical characteristics of extranodal DLBCLs of the maxilla and the mandible [2, 3]. Patients with DLBCL of the oral cavity and oropharynx have low survival rates, and very few published reports describe their clinical characteristics [4,5,6]. The clinical manifestations of DLBCL that present in the maxilla and mandible may have features unique to their anatomical location but reports that clarify these details are lacking. This study aims to describe symptomatic and imaging features of DLBCL in the maxilla and mandible, compare the differences in clinical presentation between the maxilla and the mandible, and report on the survival rates of these patients
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