Extranodal Hodgkin's lymphoma of the oral soft tissue

Abstract

Cervical lymphadenopathy is the most common head and neck presentation for Hodgkin's lymphoma (HL). Although uncommon, extranodal HL observed at the time of diagnosis is well documented and is typically associated with generalized disease and a consequence of local spread from adjacent lymph nodes. Extranodal HL of the upper aerodigestive tract soft tissue is extremely rare, but has been reported to involve the oral cavity, oropharynx, nasopharynx, and larynx. Two cases of extranodal HL of the oral soft tissue are being reported. A 32-year-old male presented with a 5.0-cm ulcerated lateral palatal swelling and a history of recently diagnosed HL. Clinical impression was palatal abscess, r/o HL. Diagnosis on biopsy was malignant lymphoid infiltrate, consistent with HL. The patient was determined to have stage IV HL, with involvement of the low pelvic area, oral cavity, and cervical lymph node chain. A second case of extranodal HL of the oral soft tissue was identified in a 70-year-old female as a swelling of the floor of the mouth. Clinical impression was mucocele, r/o salivary gland tumor. The biopsy specimen was diagnosed on routine microscopy as consistent with lymphocyte-predominant HL. The diagnosis was confirmed by immunohistochemical analysis. A diagnosis of stage I HL was made based on the absence of any detectable sites of involvement outside of the oral cavity. After treatment, the patient was considered free of disease at 6-month follow-up. These 2 cases contribute to the paucity of cases documented in the literature of extranodal HL of oral soft tissues. Cervical lymphadenopathy is the most common head and neck presentation for Hodgkin's lymphoma (HL). Although uncommon, extranodal HL observed at the time of diagnosis is well documented and is typically associated with generalized disease and a consequence of local spread from adjacent lymph nodes. Extranodal HL of the upper aerodigestive tract soft tissue is extremely rare, but has been reported to involve the oral cavity, oropharynx, nasopharynx, and larynx. Two cases of extranodal HL of the oral soft tissue are being reported. A 32-year-old male presented with a 5.0-cm ulcerated lateral palatal swelling and a history of recently diagnosed HL. Clinical impression was palatal abscess, r/o HL. Diagnosis on biopsy was malignant lymphoid infiltrate, consistent with HL. The patient was determined to have stage IV HL, with involvement of the low pelvic area, oral cavity, and cervical lymph node chain. A second case of extranodal HL of the oral soft tissue was identified in a 70-year-old female as a swelling of the floor of the mouth. Clinical impression was mucocele, r/o salivary gland tumor. The biopsy specimen was diagnosed on routine microscopy as consistent with lymphocyte-predominant HL. The diagnosis was confirmed by immunohistochemical analysis. A diagnosis of stage I HL was made based on the absence of any detectable sites of involvement outside of the oral cavity. After treatment, the patient was considered free of disease at 6-month follow-up. These 2 cases contribute to the paucity of cases documented in the literature of extranodal HL of oral soft tissues.