Extranodal lymphoma arising within the maxillary alveolus: a systematic review

David MacDonald,Sean Lim

doi:10.1007/s11282-017-0309-5

Abstract

ObjectivesExtranodal lymphomas affecting the head and neck infrequently arise within the jaw bones. Although clinical examination and conventional radiography may initially suffice for such lesions arising within the mandible, those arising within the maxillary alveolus generally require cross-sectional imaging because of the complex anatomy of this region. This study was performed to determine the prevalence, demographic characteristics, and clinical presentations of these lesions and the imaging modalities used for their diagnosis.Study designA systematic review (SR) on case series and another SR on case reports were performed to investigate the demographic, clinical, and radiological features of extranodal lymphomas arising within the maxillary alveolus.ResultsMost case series were derived from just four nations, whereas the case reports were derived from a wider range of ethnicities. The more detailed case reports significantly reported at least one imaging modality. Most patients were aware of their lesions for nearly 2 months before presentation. The most frequent symptom was swelling. Most case reports included a provisional diagnosis, the most frequent of which was dental infection followed by squamous cell carcinoma.DiscussionExtranodal lymphomas arising within the maxillary alveolus were sufficiently frequent in four communities to be reported in two or more case series, and the occasional single case report indicated that such lesions are more widespread globally. Although the SR on case series revealed differences in the relative period prevalence and maxillary/mandibular ratio, the SR on case reports revealed details of the clinical presentation and imaging modalities used.

Highlights

Lymphoma accounts for about 5% of head and neck malignancies [1]
Forty-six reports satisfied the selection criteria: 4 of the 146 hits in the search of the Medical Subject Heading (MeSH) terms “Lymphoma AND Jaw,” 24 of the 739 hits in the search of the text words “lymphoma AND jaw,” 4 of the 105 hits in the search of the text word “non-Hodgkin lymphoma maxilla,” and 14 reports obtained from the reference lists and hand-searching
Velez and Hogge [44] reported only B-cell non-Hodgkin lymphoma (NHL), and Kemp et al [45] grouped NHLs arising in the maxillary alveolus together with those arising in the hard palate

Summary

Introduction

Lymphoma accounts for about 5% of head and neck malignancies [1]. During the last 50 years, a new classification of lymphoma has appeared almost every decade; the 2016 revision of the World Health Organization classification [2] is the most recent. Thirty percent of lymphomas arise in tissues outside the lymph nodes These are called extranodal lymphomas [1] and can be either HL or NHL [3]. A possible cause of the initial accumulation of lymphoid tissue (from which the lymphoma arises) within the jawbones is chronic dental disease, which may arise from an untreated or inadequately treated nonvital tooth or periodontal disease. Such lesions affecting the mandibular alveolus are adequately displayed by the conventional radiography, those in the maxillary alveolus are not readily displayed. Cross-sectional imaging modalities, including cone-beam computed tomography (CBCT), are necessary for lesions arising within the

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