Primary extranodal Non-Hodgkin`s lymphoma presenting as painful gingval swelling
Primary extra-nodal non-Hodgkin’s lymphomas (NHL) constitute 25–40% of NHL but less than 1% arises in oral cavity. Here in 53-year-old man with stage IE gingival diffuse large B cell lymphoma who was treated successfully with chemotherapy and radiotherapy was presented.
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Інститут експериментальної патології, онкології і радіобіології ім. Р.Є. Кавецького НАН України
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| Zitieren: | Primary extranodal Non-Hodgkin`s lymphoma presenting as painful gingval swelling / Y. Urun, F. Can, E. Baris, H. Akbulut, G. Utkan, F. Icli // Experimental Oncology. — 2012. — Т. 34, № 2. — С. 134-135. — Бібліогр.: 6 назв. — англ. |
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Urun, Y. Can, F. Baris, E. Akbulut, H. Utkan, G. Icli, F. 2018-06-19T11:39:40Z 2018-06-19T11:39:40Z 2012 Primary extranodal Non-Hodgkin`s lymphoma presenting as painful gingval swelling / Y. Urun, F. Can, E. Baris, H. Akbulut, G. Utkan, F. Icli // Experimental Oncology. — 2012. — Т. 34, № 2. — С. 134-135. — Бібліогр.: 6 назв. — англ. 1812-9269 https://nasplib.isofts.kiev.ua/handle/123456789/138686 Primary extra-nodal non-Hodgkin’s lymphomas (NHL) constitute 25–40% of NHL but less than 1% arises in oral cavity. Here in 53-year-old man with stage IE gingival diffuse large B cell lymphoma who was treated successfully with chemotherapy and radiotherapy was presented. en Інститут експериментальної патології, онкології і радіобіології ім. Р.Є. Кавецького НАН України Experimental Oncology Case report Primary extranodal Non-Hodgkin`s lymphoma presenting as painful gingval swelling Article published earlier |
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Primary extranodal Non-Hodgkin`s lymphoma presenting as painful gingval swelling |
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Primary extranodal Non-Hodgkin`s lymphoma presenting as painful gingval swelling Urun, Y. Can, F. Baris, E. Akbulut, H. Utkan, G. Icli, F. Case report |
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Primary extranodal Non-Hodgkin`s lymphoma presenting as painful gingval swelling |
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Primary extranodal Non-Hodgkin`s lymphoma presenting as painful gingval swelling |
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Primary extranodal Non-Hodgkin`s lymphoma presenting as painful gingval swelling |
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Primary extranodal Non-Hodgkin`s lymphoma presenting as painful gingval swelling |
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primary extranodal non-hodgkin`s lymphoma presenting as painful gingval swelling |
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Urun, Y. Can, F. Baris, E. Akbulut, H. Utkan, G. Icli, F. |
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Urun, Y. Can, F. Baris, E. Akbulut, H. Utkan, G. Icli, F. |
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2012 |
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Experimental Oncology |
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Інститут експериментальної патології, онкології і радіобіології ім. Р.Є. Кавецького НАН України |
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Primary extra-nodal non-Hodgkin’s lymphomas (NHL) constitute 25–40% of NHL but less than 1% arises in oral cavity. Here in 53-year-old man with stage IE gingival diffuse large B cell lymphoma who was treated successfully with chemotherapy and radiotherapy was presented.
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1812-9269 |
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https://nasplib.isofts.kiev.ua/handle/123456789/138686 |
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Primary extranodal Non-Hodgkin`s lymphoma presenting as painful gingval swelling / Y. Urun, F. Can, E. Baris, H. Akbulut, G. Utkan, F. Icli // Experimental Oncology. — 2012. — Т. 34, № 2. — С. 134-135. — Бібліогр.: 6 назв. — англ. |
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134 Experimental Oncology 34, 134–135, 2012 (June)
PRIMARY EXTRANODAL NON-HODGKIN’S LYMPHOMA
PRESENTING AS PAINFUL GINGIVAL SWELLING
Y. Ürün1, F. Can2, E. Barış3, H. Akbulut1, G. Utkan1, F. İçli1
1Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey
2Department of Internal Medicine, Ankara University School of Medicine, Ankara, Turkey
3Department of Oral Pathology, Gazi University Faculty of Dentistry, Ankara, Turkey
Primary extra-nodal non-Hodgkin’s lymphomas (NHL) constitute 25–40% of NHL but less than 1% arises in oral cavity. Here in 53-year-old
man with stage IE gingival diffuse large B cell lymphoma who was treated successfully with chemotherapy and radiotherapy was presented.
Key Words: gingival lymphoma, primary extra-nodal non-Hodgkin’s lymphomas.
Non-Hodgkin’s lymphomas (NHLs) are hetero-
geneous disease and diffuse large B cell lymphoma
(DLBCL) is the most common type which represents
about 30% of all NHL [1, 2]. DLBCL is an aggressive
lymphoma and like most NHLs, there is a male pre-
dominance. Although the most NHLs arise in lymph
nodes, 25–40% of patients with NHL present with extra
nodal involvement. Whereas the definition of primary
extra-nodal NHL (PE-NHL is a controversial issue,
especially in patients with both nodal and extra nodal
sites involvement. The incidence of PE-NHL is increas-
ing worldwide [2–5]. Although NHLs can involve any
organ and tissue, the most of PE-NHL arise from gas-
trointestinal tractus but in less than 1% of the patients
the initial sites may be in oral cavity [3–6].
Patients with DLBCL typically present with a pro-
gressive enlargement of a mass, most usually lymph
node enlargement in the neck or abdomen. “B”
symptoms (i.e., fever, weight loss, night sweats)
are observed in approximately 30% of patients,
and the serum LDH is elevated in over one-half [3].
In the extra-nodal disease, patients present with the
concerned organ’s symptoms. As it can be difficult
to diagnose and diffuse B cell lymphoma is aggres-
sive in the atypical presentation the lymphomas have
to be kept in mind. A combination of chemotherapies
and the monoclonal antibody rituximab (R) can lead
to a cure in a large number of people with this form
of lymphoma. The most common regime is R-CHOP
or CHOP for 6–8 cycles. Patients in early stages also
benefit from radiation to involved areas [3, 6].
The purpose of this report is to demonstrate a case
of extra-nodal DLBCL arising on the gingiva and to em-
phasize the difficulty of the diagnosis of the gingival
disease not improved with routine dental treatment.
A 53-year-old man was admitted to our clinic with
3 months complaint of teeth and gingival pain at Decem-
ber 2010. His teeth were pulled out after a course of an-
tibiotic therapy but his complaints got worsened (Fig. 1).
Fig. 1. Pretreatment gingival appearance of patient
A gingival biopsy from the left premolar side was
done by his dentist. The histological examination of the
biopsy revealed that a tumoral infiltration consisting
of cells with large nucleus, prominent nucleolus and
insignificant cytoplasm (Fig. 2 and 3).
Fig. 2. Oral submucosal tissue completeley filled with tumoral
mass (Hematoxylin&Eosin x40)
Received: May 20, 2012.
Correspondence: E-mail: yukselurun@gmail.com
Abbreviations used: CT — computerized tomography; DLBCL —
diffuse large B-cell lymphoma; NHL — non-Hodgkin’s lymphomas;
PE-NHL — primary extra-nodal NHL.
Exp Oncol 2012
34, 2, 134–135
LETTER TO EDITOR
Experimental Oncology 34, 134–135, 2012 (June)34, 134–135, 2012 (June) (June) 135
Fig. 3. Sheet-like tumoral mass was composed of large cells
with pale nuclei. Number of atypical mitotic figures were seen
(arrow) (Hematoxylin&Eosin x40)
The immunohistochemical examination showed
staining of tumor cells with CD45, CD20, and vimentin
but S100, SMA, and keratin were negative (Fig. 4).
Fig. 4. Tumor cells were diffuse positive with CD20 (DAB x200) (B)
He had a gingival pain, paresthesia at his chin on the
administration. The physical examination and complete
blood count, biochemical investigations, and chest x-ray
were within normal limits. The patient’s beta 2 micro-
globulin level was 2 mg/L (normal range: 0,7–1,8 mg/L)
and LDH and ESR was in the normal range. In addition,
lymphoma infiltration was not observed at evaluation
of bone marrow aspiration and biopsy. The computerized
tomography (CT) evaluation of neck, thorax, and abdo-
men revealed no abnormality. The patient was treated
with four cycles of R-CHOP (rituximab 375 mg/m2,
cyclophosphamide 750 mg/m2, doxorubicin 50 mg/m2,
vincristine 1.4 mg/m2 (for a maximal dose of 2 mg), and
oral prednisone 100 mg/d on days 1–5) chemotherapy
with a final diagnosis of stage 1E DLBCL. Following
four cycles of chemotherapy, he was given a total dose
of 4000 cGy divided into 20×200 cGy fractions to the
involved field. After 4 cycles of CT and IFRT, complete
response was achieved and the patient has been fol-
lowed up for 18 months without any evidence of relapse.
PE-NHLs of oral cavity usually presents with an as-
ymptomatic gingival hypertrophy or a mass of tissue
mimicking common oral and dental pathologic condi-
tions. Therefore, the diagnosis of the lymphoma can
be delayed. In our case, the patient had gingival pain
so he had gone to a dentist and had some teeth pulled
out. Because of the worsening symptoms a gingival
biopsy was done, which showed the malign infiltration
and its treatment led to a cure of a malign disease.
CONFLICT OF INTEREST
None
REFERENCES
1. WHO classification of tumours of haematopoietic and
lymphoid tissues. 4th ed. S.H. Swerdlow. 2008, Lyon, France.
International Agency for Research on Cancer.
2. Flowers CR, Sinha R, Vose JM. Improving outcomes
for patients with diffuse large B-cell lymphoma. CA Cancer
J Clin 2010; 60: 393–408.
3. Krol AD, le Cessie S, Snijder S, et al. Primary extranod-
al non-Hodgkin’s lymphoma (NHL): the impact of alternative
definitions tested in the Comprehensive Cancer Centre West
population-based NHL registry. Ann Oncol 2003; 14: 131–9.
4. Chua SC, Rozalli FI, O’Connor SR. Imaging features
of primary extranodal lymphomas. Clin Radiol 2009; 64: 574–88.
5. Zucca E. Extranodal lymphoma: a reappraisal. Ann
Oncol 2008; 19: iv77–80.
6. Lal A, Bhurgri Y, Vaziri I, et al. Extranodal non-Hodg-
kin’s lymphomas — a retrospective review of clinico-pathologic
features and outcomes in comparison with nodal non-Hodg-
kin’s lymphomas. Asian Pac J Cancer Prev 2008; 9: 453–8.
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