Himachal Dental

Extranodal Non Hodgkin Lymphoma

Posted in Oral Surgery by UK Dental Tourism on January 14, 2010

Non-Hodgkin lymphoma (NHL) is uncommon. It is the second most common group of malignancies, behind only squamous cell carcinoma.It accounts for 3.5% of intraoral malignancies but rarely arises on gingiva.Most of these are high grade diffuse large B -Cell lymphomas. Diagnosis of an NHL of the oralcavity is often diifficult bacause it may resemble other conditions such as dental abcesses or can mimic other pathological conditions  eg. fibroma ,periodontal disease.

The radigraphic aspect of NHL is also not chracteristic. Frequently,NHL presents as a local ,painless swelling without ulceration andaccompnied by pain or discomfort in the throat .These local symtoms can also be associated with systemic symtoms called  B -Symtoms.Lymphoma should be considered in he presence of a gingival swelling accompnied by tooth mobility, ulceration and unexplained dental pain or numbness.Histologic and immunophenotypic studies are therefore important in establshing the diagnosis.Most patiets with NHL of the head and neck have , at presentation , a stage 1 or 2 high grade diffuse large B-Cell Lymphoma.

According to Ann Arbor Staging Classification , the lymphomas can be classified as :

The principal stage is determined by location of the tumor:

* Stage I indicates that the cancer is located in a single region, usually one lymph node and the surrounding area. Stage I often will not have outward symptoms.
* Stage II indicates that the cancer is located in two separate regions, an affected lymph node or organ and a second affected area, and that both affected areas are confined to one side of the diaphragm – that is, both are above the diaphragm, or both are below the diaphragm.
* Stage III indicates that the cancer has spread to both sides of the diaphragm, including one organ or area near the lymph nodes or the spleen.
* Stage IV indicates diffuse or disseminated involvement of one or more extralymphatic organs, including any involvement of the liver, bone marrow, or nodular involvement of the lungs.

Modifiers.These letters can be appended to some stages:

* A or B: the absence of constitutional (B-type) symptoms is denoted by adding an “A” to the stage; the presence is denoted by adding a “B” to the stage.
* E: is used if the disease is “extranodal” (not in the lymph nodes) or has spread from lymph nodes to adjacent tissue.
* X: is used if the largest deposit is >10 cm large (“bulky disease”), or whether the mediastinum is wider than 1/3 of the chest on a chest X-ray.
* S: is used if the disease has spread to the spleen.

Type of staging

The nature of the staging is (occasionally) expressed with:

* CS – clinical stage as obtained by doctor’s examinations and tests.
* PS – pathological stage as obtained by exploratory laparotomy (surgery performed through an abdominal incision) with splenectomy (surgical removal of the spleen). Note: exploratory laparotomy has fallen out of favor for lymphoma staging.

Treatment of  extranodal NHL includes surgical excision followed by chemotherapy sometimes with associateds radiotherapy.Primary NHL of gingiva can mimic other lesions.It is therefore necessary to perform a histologic examination in cases where signs and symtoms persist,despite treatment . An yearly biopsy will provide an approprite diagnosis and avoid disease progression ,thus improving the pronosis.

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