Non-Hodgkin's Lymphoma in the Mandible: Case Report

Malignant lymphoma of the oral region is uncommon and accounts for approximately 3.5% of all oral malignancies. Non-Hodgkin’s lymphoma occurs primarily in adults, although children may also be affected, particularly by the more aggressive intermediate and high-grade forms. The condition most commonly develops in the lymph nodes, but so-called extra nodal lymphoma is also found. In children, extanodal lymphoma is more common. The presentation can be as a non tender mass mostly in cervical, auxiliary, or inguinal regions that has been enlarging for months. In the oral cavity, lymphoma appears usually as extra nodal disease. The malignancy may develop in the oral soft tissues or centrally within the jaws. Soft tissue lesions appear as non-tender, diffuse swelling; they most commonly affect the buccal vestibule, posterior hard palate, or gingiva. The patient may complain of paresthesia, particularly with a mandibular lesion (numb chin syndrome). Case report: An 8-year-old boy was visited in the Oral Medicine Department of Mashhad Dental School with the chief complaint of permanent tooth mobility in the oral cavity for 15 days. The patient also had a history of bone pain mainly in lower lip for the last month and Bell’s palsy (left side) was observed which had been occurred since 7 days before. Simultaneously, the patient had malaise, anorexia, bone pain, illness, lymphadenopathy (head and neck), and flu like signs and symptoms, fatigue and leukocytosis. Under clinical diagnosis of lymphoma, the patient was referred to pediatric hematologist-oncologist. Our diagnosis, none Hodgkin’s lymphoma (NHL), was confirmed by the report of lymph node biopsy.

Dentists can play an important role in the early detection of the malignant lymphoma of the oral cavity. NHL primarily appears in the head and neck. It is typically characterized by a swollen, non-painful lymph node although other presentations may pose significant diagnostic problems and frequently lead to misdiagnosis and mistreatment.