TITLE:
Malignant Lymphoma with Initial Symptoms in the Mandibular Region
AUTHORS:
Yumi Mochizuki, Hiroyuki Harada, Kei Sakamoto, Kou Kayamori, Shin Nakamura, Minoru Ikuta, Yuji Kabasawa, Eriko Marukawa, Hiroaki Shimamoto, Fumihiko Tushima, Ken Omura
KEYWORDS:
Mandible, Diffuse Large B Cell Lymphoma, B-Cell Lymphoma Unclassifiable with Features Intermediate between DLBCL and Burkitt Lymphoma, B-Cell Lymphoblastic Lymphoma, The Inferior Alveolar Nerve
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.6 No.7,
July
13,
2015
ABSTRACT: Primary intraosseous
lymphoma is rare and there are few case reports manifesting with a mass in the
mandible. Thus, we retrospectively reviewed and analyzed the clinical
characteristics, treatment, and outcome of extranodal non-Hodgkin’s lymphoma
(NHL) with initial mandibular symptoms in our department. At initial treatment
of dental clinics, dentists had diagnosed as dental or gingival diseases and had performed dental
treatment. Neurological disorder to involvement of the inferior alveolar nerve
was present in 80.0% of our cases. On dental or panoramic radiography a
specific radiolucent lesion in the mandible was not detected, except for dental
lesions. On CT, NHL of the mandible region has no widening and no clear
destruction but a slit-like the cortex bone destruction pattern with keeping in
shape of the mandibular body (62.5%
of CT-examined cases), and extraosseous soft tissue mass are clearer on MRI (100.0% of
MRI-examined cases). Histopathologically, 80.0% of our cases were diagnosed as
diffuse large B cell lymphoma (DLBCL). One case as B-cell lymphoblastic
lymphoma and one case as B-cell lymphoma unclassifiable with features
intermediate between DLBCL and Burkitt lymphoma were Stage IV (Ann Arbor
staging system) and had poor prognosis. The disease-specific survival rate was
77.8% at 5 years. If unexplained non-specific symptoms such as swelling of the
jaw, pain, neurological disorder of the inferior alveolar nerve, tooth mobility
are observed, oral surgeons and dentists should not perform dental treatments.
CT and MRI show disease specific appearance to be able to give a definitive
diasnosis as NHL. PET/CT is useful for scaninng of whole body. A deep bone
biopsy is preferred for suspected malignant lymphoma.