Non-Hodgkin lymphoma - Oral Mucosal Lesion
Histiocytic lymphomas are rare in the oral cavity. Oral NHL (non-Burkitt's type) is a disease of adults. Patients notice a non-tender swelling or mass in the palate or gingiva, or enlargement of the jawbones (usually the mandible) if the lymphoma is intra-osseous. There may be vague pain and discomfort and/or a sensation of pressure. Mandibular lesions may cause mental nerve paresthesia.
The oral presentation may be part of systemic nodal lymphoma in which case lymph nodes (such as in the neck) may be enlarged, firm, and matted. T-cell lymphomas by virtue of their location in the nasal cavity cause nasal stuffiness and epistaxis.
In Stage III and IV disease, fever, weight loss, and night sweats (also called B symptoms) may be present.
Patients who are immunocompromised (eg, patients with combined variable immunodeficiency or AIDS) and those who have immune dysregulation (eg, those with Sjögren syndrome) are prone to developing lymphoma. Patients who have received organ transplants (eg, hematopoietic stem cell or heart transplants) are prone to developing EBV-associated lymphoma.
C85.90 – Non-Hodgkin lymphoma, unspecified, unspecified site
118601006 – Non-Hodgkin's lymphoma
Differential Diagnosis & Pitfalls
- Oral NHL, B-cell type
- Dental abscesses are painful, fluctuant, and associated with carious, infected teeth. They are of acute onset.
- Vascular tumors such as lobular capillary hemangioma (pyogenic granuloma), hemangioma, or Kaposi sarcoma may appear similar.
- Squamous cell carcinoma should also be considered.
- Other soft tissue tumors, malignant or otherwise, should be considered (eg, neurofibromas often present as a diffuse swelling of the palate).
- T-cell lymphoma
- Granulomatosis with polyangiitis presents as a destructive ulcer of the palate or with strawberry-like gingival nodules. Patients are often pANCA and cANCA positive, and there may be involvement of the kidneys.
- Deep fungal infection, especially in immunocompromised patients and diabetics, may appear similar. A biopsy confirms the diagnosis.
- Chronic cocaine use with perforation of the palate appears similar, but the history confirms the diagnosis.
- Necrotizing sialometaplasia tends to present with a punched-out, clean ulcer on the palate that evolves and resolves over a few weeks.
- Burkitt's lymphoma
- Odontogenic cysts such as odontogenic keratocysts can cause jaw expansion and facial swelling in children. When associated with the Gorlin-Goltz syndrome, lesions may also be bilateral.
- Odontogenic tumors in the mandible tend to occur in a slightly older age group.
- Non-odontogenic tumors such as central giant cell granuloma tend to occur in young patients and cause facial swelling. Biopsy is diagnostic.
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