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

Abstract

Non-Hodgkin's lymphoma has the propensity to affect non-lymphoid tissue including oral tissue. Primary non-Hodgkin's lymphoma of the mandible mistreated as chronic periodontitis with diffuse enlargement of the mandibular canal and ice-cold numbness is very rarely described in English medical literature. A 57-year-old patient presented with a painful swelling on the left side of the mandible with a clinically chronic periodontitis associated with ice-cold numbness. A panoramic radiograph showed a diffuse uniform enlargement of the mandibular canal. Histological examination showed that the lesion was a primary intraosseous non-Hodgkin's lymphoma of the mandible. Immunohistochemical examination showed a positive reaction for CD20+, Ki-67+. Seven months after chemotherapy the patient was observed for possible life-threatening propagation of the disease. In conclusion, primary (extra-nodal) non-Hodgkin's lymphoma of the mandible usually clinically presents with bone swelling, teeth mobility and neurological disturbance. Radiographic features presenting as diffuse enlargement of the mandibular canal could be considered as non-Hodgkin's lymphoma.

Unilateral widening of the inferior alveolar nerve canal: a rare anatomic variant mimicking disease

“…The most common radiological finding in the mandible is a focal or diffuse osteolytic area, generally without edge sclerosis [25,26]. Fusiform widening of the mandibular canal [27][28][29] or the mental foramen may also be observed [25]. In the head and neck, these lymphomas typically present around the age of 40-46 years [26,30] with bony swelling, pain, and sensory disturbances.…”

Common conditions associated with mandibular canal widening: A literature review

“…Other radiographic findings include loss of cortical definition, widening of the periodontal ligament, nasal cavity and cavernous sinus enlargement, mental foramen widening, and dilation of the mandibular canal 378. Buric et al,9 and Bertilotto et al10 reported that non-Hodgkin lymphomas of the mandible are rare, but can cause diffuse continuous widening of the mandibular canal (Fig. 1) associated with ice-cold numbness.…”

“…Non-Hodgkin lymphoma of the mandible may involve the canal via 2 mechanisms. It may arise from the bone, wrap around the mandibular canal, and infiltrate into it later, or it may arise from the lymphoid tissue of the mandibular canal, grow with neural and perineural spreading, and slowly expand or destroy the surrounding bone over time 9…”

Unilaterally Enlarged Mandibular Foramina and Canal Associated With Hyperplastic Lymphatic Tissue of Inferior Alveolar Nerve: Case Report and Short Literature Survey

“…The differential diagnosis of enlarged foramen and canal is manifold and includes lymphoma (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21), peripheral nerve sheath tumor (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34), primary sarcoma (35)(36)(37)(38), locally invasive carcinoma of the mucous membranes (39)(40)(41)(42)(43)(44)(45), distant metastasis (46,47), osteomyelitis (48), lipoma (49,50), hemangioma (51), idiopathic (52) and iatrogenic (53) bone defects, as well as various syndromes (54)(55)(56). Unilaterally enlarged mental foramen on a radiograph is suspected to indicate an underlying neoplastic process, predominantly tumors arising from lymphatic or nerve sheath cells…”