Primary lymphoma of the mandible

Abstract

The mandible is an uncommon presentation site for lymphoma and misdiagnosis is common. Eleven patients with lymphoma of the mandible were seen between 1947 and 1983. In 5 of the 11 patients, the diagnosis of lymphoma could not be established from the initial biopsy and additional material for examination was required. In three patients, this resulted in a partial or total removal of the mandible. In a recent histopathologic review, the diagnosis of diffuse large cell was made in seven, diffuse undifferentiated (non-Burkitt's) in two, diffuse undifferentiated (Burkitt's) in one, and unclassified in one. Using the Ann Arbor method of staging, six patients were determined to have stage IE disease; three had stage IIE, and two had stage IV. In 10 patients definitive treatment consisted of radiotherapy, chemotherapy, or a combination of both. Treatment was limited to surgery in one patient. The 5-year overall and disease-free survival rates were 62% and 50%, respectively. These results are comparable to those for lymphoma of other extranodal head and neck sites.

Radiographic Enlargement of Mandibular Canal as an Extranodal Primary Non-Hodgkin’s Lymphoma Early Sign in an Asymptomatic Patient

“…Previous reports on lymphoma demonstrated a single expansion of the bone, with no bone destruction [24, 25]. A classical but not frequent [17, 26] radiologic finding in head and neck lymphoma is ill defined or lytic destruction, suggestive of malignant neoplasms or osteomyelitis [11]; however, the imaging features of the present case resemble a benign lesion more than a malignancy.…”

“…In spite of this finding, clinical presentation of NHL extranodal bone lesions usually includes history of swelling, pain, paresthesia, or hyperesthesia along alveolar nerve extension and distribution, as well as lymphadenopathy [11]. Hyperesthesia may be related to compression or infiltration of the inferior alveolar nerve [24]. Other unspecific symptoms, such as tooth mobility, may refer to dental abscess or osteomyelitis [27, 28], especially to lymphomas at alveolar process, which are confounders to the NHL diagnostic [13].…”

Radiographic enlargement of mandibular canal as first feature of non-Hodgkin's lymphoma

“…The possibility of late diagnosis of PNHL should be stressed as every second patient had delayed diagnosis in the reported series of 11 mandibular non-Hodgkin's lymphoma. 13 In this case of PNHL, the final diagnosis was established through histological examination of the biopsy specimen, coupled with immunohistochemical phenotyping. Monoclonal antibodies used as markers, CD20+ (a selective marker for identifying a subpopulation of B-cells and granulocytes) and Ki-67+ (for identifying high proliferative cell activity) were important for enabling the diagnosis of mandibular nonHodgkin's lymphoma, B-cell type.…”

Lymphome non hodgkinien à localisation mandibulaire : à propos de deux observations

“…Robbins et coll. ont observé un élargissement du foramen mentonnier accompagné d'images radiostransparentes chez un patient atteint d'un lymphome mandibulaire [12] . L'hyperesthésie, parfois observée dans le territoire nerf mentonnier, peut être secondaire à une compression ou à une infiltration du nerf alvéolaire inférieur [11] .…”

“…Dans une étude portant sur onze cas de lymphome mandibulaire, les auteurs montrent que dans cinq cas, la première biopsie n'avait pas permis de poser le diagnostic de LNH. Cette difficulté diagnostique est due principalement à l'infiltrat inflammatoire qui peut masquer les cellules tumorales et aux lymphoblastes qui sont des cellules très fragiles [12] . Le traitement des LNHE dépend du type histologique et du stade : en général, il comporte une exérèse chirurgicale de la lésion, suivie d'une chimiothérapie et/ou d'une radiothérapie [4] .…”