Cranio-maxillofacial non-Hodgkin’s lymphoma: Clinical and histological presentation
Introduction
Malignant lymphoma represents approximately 5% of all malignant lesions of the head and neck. It is the second most common malignant lesion of the head and neck. The most common malignancy is squamous cell carcinoma (DePena et al., 1990, Vega et al., 2005). Lymphoma has traditionally been categorised as either Hodgkin’s and non-Hodgkin’s lymphoma. Non-Hodgkin lymphoma (NHL) originates from B- or T-cell of lymphatic tissue, with plasmocytoma being a special clinical entity manifesting primarily in the bone marrow. Up to 40% of non-Hodgkin lymphomas present at an extranodal site. Extranodal non-Hodgkin lymphoma most frequently occurs in the gastrointestinal tract. The head and neck is the second most frequent site of extranodal manifestation (Vega et al., 2005). Primarily extranodal manifestations often involve regional or generalized nodal disease (Epstein et al., 2001). The World Health Organisation’s classification of non-Hodgkin’s lymphoma has been accepted by most pathologists and clinicians as a worldwide consensus classification system (Jaffe, 2009, Tan, 2009). It is based on distinct disease entities that can be defined by specific morphological, immunological, genetic and clinical parameters (Stein, 2000).
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Material and methods
In this study, 42 patients with malignant non-Hodgkin’s lymphoma were included. They presented first at the Department of Oral and Maxillofacial Surgery of the University Hospital with unspecific swelling in the head and neck area in the time from 1993 to 2010. All data were retrospectively reviewed. Patient data obtained are shown in Table 1. All patients underwent surgical biopsy of the tumour. Histopathological analysis and immunhistochemical staining were performed by the Department of
Results
All patients in this study were submitted directly to the department of oral and maxillofacial surgery. The histological diagnosis was made in our department for all patients. All referrals were based on clinical findings of unspecific swelling in the head and neck area by the general practitioner or dentist. The mean age at diagnosis was 64 years (range 1–91 years, SD 18 years). Twenty-three patients (55%) were female. In 26 patients (62%) the first clinical presentation of NHL was extranodal, 9
Discussion
Malignant NHL manifested at a nodal site in about 70% of all cases, only 30% manifested at an extranodal site (Zucca et al., 2002).
Most cases of extranodal B-cell lymphoma present in the gastrointestinal tract as MALT-lymphoma (mucosa-associated lymphoid tissue). The head and neck region is the second most common site of extranodal lymphomas (Vega et al., 2005).
In our study, the most common first clinical presentation was a single extranodal site (60%). In 10 of 42 patients the first clinical
Conclusion
Non-Hodgkin lymphoma is a frequent differential diagnosis in tumours of the head and neck, representing about 5% of all malignant tumours in the area. Therefore, it should be considered as a possible diagnosis by oral and maxillofacial surgeons as well as dentists who see patients with unspecific head and neck swelling.
We therefore strongly recommend that patients with NHL should be treated by oncologists according to standard treatment protocols. Good interdisciplinary cooperation between
Conflict of interest
All authors disclose any financial and personal relationships with other people or organisations that could inappropriately influence or bias our work.
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