Title : Two rare non Hodgkin’s lymphoma cases emphasizing the diagnostician role of oral surgeons.
Abstract:
Lymphomas are a heterogeneous group of malignant tumors of the haematopoietic system divided into two major categories: Hodgkin’s lymphoma and non-Hodgkin’s (NHL). NHL may present an intranodal site, or in 40% of cases an extranodal one: the oral cavity and digestive tractus being its main extranodal locations. According to the specific subtype of the lymphoid cells involved, more than 20 different types of NHL have been recorded through the WHO classification. Therefore, we are presenting two highly aggressive known NHL presenting both a mandibular location. The first one is about a 72-year-old female patient who was diagnosed with a large B-cell lymphoma: the most common type of NHL originating from the germinal center and usually presented as rapidly enlarging. The patient presented a gingival bleeding lesion having locally ulcerated raised edges. Her CT scan revealed infiltration of the right lateral mandibular soft tissues associated with a poorly limited osteolytic lesion affecting the mandible crest. Fortunately, the lymphoma was diagnosed at an early stage, thus the patient was referred to the onco-hematology department where she received a chemotherapy-based treatment. She showed a clear improvement after the first cycles. The second case concerns a 16-year-old male patient diagnosed with Burkitt’s lymphoma presenting primary abdominal and secondary oral localization. His CT scan showed a tumoral mass of the ileocecal junction associated with peritoneal carcinomatosis, besides he presented a mandible extensive gingival mass ranging from the 34 to 37 teeth. The patient was surgically operated on his abdominal tumour and was referred to the onco-haematology department where a chemotherapy treatment was initiated. Unfortunately, the patient died one month later. In fact, the prognosis of NHL depends on the degree of the initial extension and the speed of treatment initiation, therefore as in our second case, a late diagnosis Is usually fatal. The common particularity of our cases was the presence of a mandible location, which is very rarely reported in NHL cases (0.6%). Nevertheless, it is one of the first signs an oral surgeon can notice: giving him an important role in the early diagnosis. In fact, the diagnosis of a NHL should be raised in front of a persistent superficial painless lymph nodes at any location, hepatomegaly, splenomegaly at an unusual context, and general signs such as weight loss, fever, etc… Once suspected, only a deep and good quality biopsy can reveal the right diagnosis of a NHL. However, since these circumstances are not very specific, clinician mislead can easily be observed making the diagnosis difficult and worsening the prognostic by delaying the treatment. Therefore, mandibular NHL should be included in the differential diagnosis of other jaw lesions despite its rareness, and a deep biopsy must always be performed in case of suspicious findings following a meticulous clinical examination.
