Primary Extranodal, Extralymphatic Hodgkin Lymphoma of the Mandible

González-Fontal, Guido R.; Rosales, Joaquín; Jaramillo, Roberto; Henao-Martínez, Andrés F

doi:10.1155/2011/387570

Cited by 9 publications

(8 citation statements)

References 11 publications

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“…Lymphomas are malignant tumours developed from cells of the lymphatic system and can therefore affect any organ containing lymphoid tissue. While Hodgkin lymphomas (HL) most often involve lymph nodes in the head and neck, non-Hodgkin lymphomas (NHL) can equally affect extra-nodal sites [ 41 ] such as the lacrimal glands, salivary glands, muscles and soft tissues of the orbit, thyroid gland, maxilla and mandible. Mandibular NHL is very rare.…”

Section: Pitfallsmentioning

confidence: 99%

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Radiolucent lesions of the mandible: a pattern-based approach to diagnosis

et al. 2013

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ObjectivesRadiolucent mandibular lesions seen on panoramic radiographs develop from both odontogenic and non-odontogenic structures. They represent a broad spectrum of lesions with a varying degree of malignant potential. The purpose of this review is to illustrate the characteristic imaging findings—as well as the clinical and histological features—of common and uncommon radiolucent lesions of the mandible.MethodsThis review article is based on the retrospective evaluation of 11,725 panoramic radiographs seen in our institution during the past 6 years. It provides a comprehensive, practical approach to the radiological interpretation of radiolucent lesions of the mandible. To facilitate the diagnostic approach, we have classified radiolucent lesions into two groups: lesions with well-defined borders and those with ill-defined borders.ResultsLesion prevalence, age of manifestation, location within the mandible, relationship to dental structures, effect on adjacent structures and characteristic findings at computed tomography (CT), cone beam CT (CBCT) and magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) are discussed. Pitfalls including malignant lesions mimicking benign disease and pseudo-lesions are equally addressed.ConclusionKnowledge of the characteristic imaging features of radiolucent mandibular lesions narrows the differential diagnosis and is crucial for the identification of those lesions, where biopsy is indicated for definitive histology.Teaching points• Panoramic X-rays, CT and MRI are essential for the work-up of radiolucent mandibular lesions.• Lesion borders, location within the mandible, relationship to dental structures and tissue characteristics on cross-sectional imaging are indispensable to narrow the differential diagnosis.• High-resolution CT and CBCT play a major role for the assessment of lesion margins and their relationship to important anatomic structures, such as the inferior alveolar nerve.• Although most radiolucent lesions with well-defined sclerotic borders are benign, MRI may reveal clinically unsuspected malignant disease.

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Section: Pitfallsmentioning

confidence: 99%

“…18 ). Radiological findings can be quite subtle such as teeth displacement in the occlusal direction and loss of the lamina dura with widening of the periodontal ligament space [ 41 ]. Rarely, mandibular NHL can present with minor osteolysis or with unilateral enlargement of the mandibular canal and mental foramen (Fig.…”

Section: Pitfallsmentioning

confidence: 99%

Radiolucent lesions of the mandible: a pattern-based approach to diagnosis

et al. 2013

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“…Some of the cases have been associated with extra-osseous involvement. Primary osseous HL confined to the bone is so rare that approximately 19 cases have been reported worldwide to date, only 12 patients with primary solitary osseous HL [ 7 - 14 ] and 7 patients with primary multifocal osseous HL disease have been reported without lymphatic manifestations [ 15 - 20 ]. Moreover, primary osseous HL presenting as a bone lesion with an associated soft tissue mass is quite unusual [ 10 , 21 - 23 ].…”

Section: Resultsmentioning

confidence: 99%

Unusual primary osseous Hodgkin lymphoma in rib with associated soft tissue mass: a case report and review of literature

Wang

Tian

et al. 2012

Diagn Pathol

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Hodgkin lymphoma (HL) typically presents as nodal lesion and may involve extranodal sites during the progression of the disease. Primary osseous HL without any lymph node association is extremely rare and only a few such cases have been described in the literature. We present a case of unusual primary HL in rib occurring in a middle-aged female patient. Computed tomography (CT) scan revealed an osteolytic lesion was located at the right second rib and was associated with a large soft tissue mass. There was no regional lymph node involvement. CT scan of neck and abdomen was performed and showed no pathologic findings, particularly no lymphadenopathy and organomegaly could be observed. Histologically, typical binucleated Reed-Sternberg (RS) cells and lacunar cells were scattered in the background of reactive inflammation with infiltration of lymphocytes, histiocytes and eosinophilic granulocytes. By immunohistochemistry, RS cells and lacunar cells were positive for CD15 and CD30 with typical membrane and paranuclear dot-like staining pattern. However, these cells were negative for Epstein-Barr virus detection by in situ hybridization. A diagnosis of primary osseous HL was made. The patient received systemic chemotherapy and local radiotherapy, and was on regular follow-up for 24 months. There was no sign of recurrence of tumor and lymph node or bone marrow involvement. Because there is a possibility of secondary bone involvement by systemic HL, strict histological analysis and thorough radiographic examination are suggested to be necessary for accurately diagnosing this tumor when it presents as a solitary bone lesion.Virtual slidesThe virtual slide(s) for this article can be found here:http://www.diagnosticpathology.diagnomx.eu/vs/2846916171507084

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“…Primary osseous HL that is limited to the bone is extremely rare, and until 2009, only 16 cases had been identified globally ( 10 ). To the best of our knowledge, ~20 cases of primary osseous HL, including 13 patients with primary solitary osseous HL and seven patients with primary multifocal osseous HL without lymphatic manifestations, have been reported ( 11 – 17 ). Li et al ( 18 ) reported ~30 HL patients with extraosseous involvement.…”

Section: Discussionmentioning

confidence: 99%

Unusual primary osseous Hodgkin’s lymphoma: A case report

et al. 2014

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Hodgkin’s lymphoma (HL) is one of the few adult malignancies that most frequently presents with a progressive, painless enlargement of the peripheral lymph nodes. A primary osseous presentation of HL, without lymph node involvement, is extremely rare. The present study describes a case of primary multifocal osseous HL in a 22-year-old female. The patient presented with pain in the lumbar-sacral-pelvic area and a prolonged fever. Pathological examination led to a diagnosis of primary multifocal osseous lymphoma, and the patient was subsequently prescribed a course of Adriamycin, bleomycin, vinblastine and dacarbazine (ABVD) chemotherapy. Following this, the patient recovered with no pain or fever, and computed tomography identified no further progression. The clinical, radiological and histological features of HL are similar to those of other medical conditions, such as tuberculosis and eosinophilic granuloma. Furthermore, in rare cases, HL may even occur in combination with multiple myeloma. This makes it difficult to diagnose the condition, which often leads to a delay in treatment. Clinicians should not ignore HL when it manifests in the unusual primary osseous form.

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Primary Extranodal, Extralymphatic Hodgkin Lymphoma of the Mandible

Abstract: Primary extranodal, extralymphatic Hodgkin lymphomas (PEEHLs) are a rare occurrence. When they are encountered, they become diagnostic challenges. We are describing the uniqueness of a case of PEEHL affecting the mandible with his early response to the available chemotherapy.

Cited by 9 publications

References 11 publications

Radiolucent lesions of the mandible: a pattern-based approach to diagnosis

Radiolucent lesions of the mandible: a pattern-based approach to diagnosis

Unusual primary osseous Hodgkin lymphoma in rib with associated soft tissue mass: a case report and review of literature

Unusual primary osseous Hodgkin’s lymphoma: A case report

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