Clinicopathological analysis of oral diffuse large B‐cell lymphoma, NOS: A systematic review

Abstract

Background Diffuse large B‐cell lymphoma, NOS (DLBCL NOS) is the commonest extranodal non‐Hodgkin lymphoma diagnosed in the oral and maxillofacial region. However, few studies are currently available and its prognostic determinants remain undefined. Purpose To analyse the available data on oral DLBCL NOS and to describe its clinicopathological features, identifying potential prognostic factors. Methods An electronic systematic search was performed using multiple databases with a specific search strategy in April 2018. All reports describing DLBCL NOS involving the oral cavity and jaw bones with sufficient clinicopathological information were assessed. Results Sixty‐three publications were included in the study, comprising 122 cases. Oral DLBCL NOS was found predominantly in elderly males (61.5%), and most often presented as an asymptomatic swelling of the gingiva. Patients commonly were HIV‐negative (36.1%), with few reports describing EBV‐positive cases (four cases/3.3%). Only eight cases presented B symptoms and most cases were classified as stage I or II (48.4%). CHOP therapy was the main treatment option (24.5%) and the overall 5‐year survival rate achieved 83%. Males and advanced Ann Arbor stage patients presented significantly lower survival rates in the univariate analysis, but no significance was found in the multivariate model. Conclusion Oral DLBCL NOS is an aggressive malignancy, but with a high survival rate.

Oral presentation of diffuse large B‐cell lymphoma: a rare entity

“…Early lesions are often attributed to inflammatory odontogenic or periodontal conditions. Other differential diagnosis to DLBCL in the oral cavity includes fibroma, pyogenic granuloma, pleomorphic adenoma, squamous cell carcinoma, soft tissue malignancies and minor salivary gland tumours. Furthermore, our patient did not complain of any B‐symptoms, which is the most common presentation.…”

“…DLBCL NOS is a rare entity in the oral cavity. A systematic review published in 2018, analysing all published oral DLBCL NOS, revealed 63 publications comprising 122 cases – 31 of which were presented in the maxillary mucosa. In this specific case, endodontic treatment was performed prior to diagnosis, which resulted in a much later accurate diagnosis.…”

“…Furthermore, our patient did not complain of any B‐symptoms, which is the most common presentation. B‐symptoms in DLBCL NOS have a very low frequency and are only present in 6.6% of the patients. In this case, an urgent incisional biopsy was performed, which was a better option than a fine needle aspiration (FNA) since an FNA often leads to tiny or atypical samples, which could result in unacceptable misdiagnosis.…”

“…The prognosis for NHL is poorer than for HL, since the disease in most cases is more advanced at the time of diagnosis. Among all NHL subtypes affecting the oral cavity and the jaw bones, diffuse large B‐cell lymphoma, not otherwise specified (DLBCL NOS), is the most frequent. Intraoral lymphomas can resemble dental abscesses, tumours or other diseases such as osteonecrosis.…”

Diagnostic difficulty of a mandibular manifestation of diffuse large B-cell lymphoma: a case report

“…Lymphomas represent about two thirds of hematologic diseases and involve 3.5% of all intra-oral malignant tumors [1]. There is a predominance among men and elderly population [2]. Two main types of lymphomas can be distinguished: Hodgkin's lymphoma and non-Hodgkin's lymphoma.…”