Diffuse Large B-Cell Lymphoma of the Mandible Diagnosed by Metagenomic Sequencing: A Case Report

Abstract

Introduction: Non-Hodgkin lymphoma (NHL) has a much higher incidence rate than Hodgkin lymphoma. Approximately 40% NHL occurs in extranodal tissues or organs, and its clinical manifestations are often nonspecific. Primary bone NHL involving the mandible is an uncommon NHL that is characterized by fever, gum swelling and toothache. Therefore, it is often misdiagnosed as oral diseases.Case Presentation: A 52-year-old female had recurrent fever for more than 1 month, with numbness in her left jaw and toothache. PET/CT showed an uptake area in the left mandible, suggesting microbial infections. However, antibacterial, and antiviral treatment were ineffective. Furthermore, metagenomic sequencing of plasma reported no pathogens, but instead showed significant copy number variations of multiple chromosomes, which highly suggested the existence of tumor. Finally, diffuse large B-cell lymphoma (DLBCL) was diagnosed by mandibular biopsy, and the patient was transferred to Hematology department for chemotherapy.Conclusion: mNGS not only assists rapid etiological diagnosis, but also helps rule out infection and diagnose malignant neoplasm.

First-Time Diagnosis and Ultrasound Features of Extranodal Lymphoma in Children

“…The initial diagnostic manifestations of intranodal lymphoma are mostly chronic, progressive, and painless lymph node enlargement, while those of extranodal lymphoma mainly consist of diverse and nonspecific symptoms of each involved organ and system. Thus, early diagnosis is essential to improve the patient's prognosis [ 8 ].…”

Primary Bone Lymphoma: A Review of the Literature with Emphasis on Histopathology and Histogenesis

“…Spinal cord compression and hypercalcemia due to osteolysis with related symptoms, such as lethargy, somnolence and constipation, are two major complications [ 2 , 9 , 22 , 23 , 24 ]. Cases of PBL involving the mandible or maxilla can manifest with toothache, loose teeth, gingiva edema and local numbness and are, therefore, often misdiagnosed as oral diseases [ 26 , 27 ]. Cases with a history of preceding trauma in the affected area have also been reported [ 18 , 28 , 29 , 30 ].…”

“…The histological and immunohistochemical appearance of PBL has been reported in a number of studies [ 2 , 3 , 4 , 7 , 8 , 9 , 14 , 15 , 16 , 18 , 19 , 20 , 22 , 23 , 24 , 25 , 26 , 27 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 ,…”

“…The findings of articles published before 2006 [ 16 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 ] were summarized in our previous review about PBL [ 78 ]. Herein, we analyze the histological and immunohistochemical features of PBL described in subsequent studies [ 2 , 3 , 4 , 7 , 8 , 9 , 14 , 15 , 18 , 19 , 20 , 22 , 23 , 24 , 25 , 26 , 27 , 69 , 70 , 71 , 72 ...…”

Diffuse Large B Cell Lymphoma of the Maxilla. A Rare Case Report Emphasizing Differential Diagnosis of Maxillary Involvement

“…Lymphomas are second most common malignant tumours and are categorized into Hodgkin's and non-Hodgkin's lymphoma (NHL). It represents 3.5% of all intraoral malignancies and is commonly seen in the sixth to the seventh decade of life with men's predilection [1]. Diffuse large B cell lymphoma is the most common tumour of NHL and it can be subcategorized by gene expression profiling into germinal center B cell-like (GCB) and activated B cell-like (ABC type or non-GCB) subtypes [2].…”