Treatment of an Oral Malignant Lymphoma by Combined Surgery and Chemotherapy-Case Report

Abstract

Lymphoma is the third most common group of malignant lesions of the oral cavity and maxillofacial region. Most of the non-Hodgkin's lymphomas (NHL) of the head and neck region are predominantly of B-cell lineage. In general, localized extranodal lymphomas are most commonly treated by radiotherapy or in combination with either surgery or chemotherapy. In this report, we presented a case of buccal and alveolar mucosal NHL with invasion into the mandible in a 65-year-old male patient, which was successfully treated by combined surgery and chemotherapy. The patient received total excision of the tumor and modified radical neck dissection. Histological examination of the surgical specimen revealed a tumor composed of sheets of large polygonal blue cells with vesicular nuclei, prominent nucleoli, and active mitotic figures. Immunohistochemical study demonstrated that the tumor cells were diffusely and strongly positive for CD20 (a B-cell marker) and moderately positive for CD138 (a plasma cell marker) but were negative for CD3 (a T-cell marker) and cytokeratin (AE1/AE3). A diffuse large B-cell lymphoma was diagnosed. The patient was subsequently treated with 6 courses of chemotherapy using R-CHOP regimen (rituximab, cyclophosphamide, hydroxydoxorubicin, oncovin, and prednisolone). The postoperative and chemotherapeutic course was smooth, and no recurrence was found 6 months after the initial surgery.