Abstract
Primary intraosseous lymphoma is rare and there are few case reports manifesting with a mass in the mandible. Thus, we retrospectively reviewed and analyzed the clinical characteristics, treat- ment, and outcome of extranodal non-Hodgkin's lymphoma (NHL) with initial mandibular symp- toms in our department. At initial treatment of dental clinics, dentists had diagnosed as dental or gingival diseases and had performed dental treatment. Neurological disorder to involvement of the inferior alveolar nerve was present in 80.0% of our cases. On dental or panoramic radiogra- phy a specific radiolucent lesion in the mandible was not detected, except for dental lesions. On CT, NHL of the mandible region has no widening and no clear destruction but a slit-like the cortex bone destruction pattern with keeping in shape of the mandibular body (62.5% of CT-examined cases), and extraosseous soft tissue mass are clearer on MRI (100.0% of MRI-examined cases). Histopathologically, 80.0% of our cases were diagnosed as diffuse large B cell lymphoma (DLBCL). One case as B-cell lymphoblastic lymphoma and one case as B-cell lymphoma unclassifiable with features intermediate between DLBCL and Burkitt lymphoma were Stage IV (Ann Arbor staging system) and had poor prognosis. The disease-specific survival rate was 77.8% at 5 years. If unex- plained non-specific symptoms such as swelling of the jaw, pain, neurological disorder of the infe- rior alveolar nerve, tooth mobility are observed, oral surgeons and dentists should not perform dental treatments. CT and MRI show disease specific appearance to be able to give a definitive di- asnosis as NHL. PET/CT is useful for scaninng of whole body. A deep bone biopsy is preferred for suspected malignant lymphoma. * Corresponding author.
Highlights
Malignant lymphoma is a malignancy of the lymphatic system with proliferation of malignant lymphoid cells or their precursors, [1] and is generally classified as either Hodgkin’s or non-Hodgkin’s lymphoma (NHL) [2]
We retrospectively reviewed the medical records of 73 cases of primary malignant lymphoma that were histopathologically diagnosed at the Department of Oral and Maxillofacial Surgery, Tokyo Medical and Dental University Hospital, between April 2001 and March 2015
Malignant lymphoma must be considered in the differential diagnosis if unexplained symptoms such as swelling of the jaw, pain, neurological disorder due to suspected involvement of the inferior alveolar nerve, tooth mobility, or cervical lymphadenopathy is present
Summary
Malignant lymphoma is a malignancy of the lymphatic system with proliferation of malignant lymphoid cells or their precursors, [1] and is generally classified as either Hodgkin’s or non-Hodgkin’s lymphoma (NHL) [2]. Huvos reported that 8 (5.8%) of 158 cases of NHL in the bone had involved the mandible [5]. There have been several reportes of malignant lymphoma of the mandible and many of them were aggressive with a poor prognosis [3] [6]. Diagnosis and treatment of the disease confer a better prognosis [3] [6]. Newer and better treatments are needed for aggressive malignant lymphomas [8]
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