Download PDF. 1 / 4 Pages. Previous article. Go back to website. Next article. Los linfomas son tumores hematológicos derivados del sistema de presentación aumenta en el caso de localizarse en el anillo de Waldeyer ( localización. Ao conjunto de aglomerados de tecido linfóide localizados na cavidade oral compostos pelas tonsilas faríngea, palatina e lingual, denomina-se anel linfático de.
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Los linfomas no Hodgkin comprenden un grupo de neoplasias con un amplio espectro de comportamiento. El tumor erade consistencia firmeynofluctuante. La quimioterapia y la radioterapia, utilizadas solas o combinadas, son las principales estrategias de saldeyer. La paciente se encuentra en seguimiento y no ha presentado waldeyeer hasta la fecha.
Primary involvement of the jaw bones is further rare . The swelling was abrupt in onset, moderately painful and had not responded to conventional therapy. Patient experienced altered sensation in the involved region and difficulty in opening her mouth.
There were no systemic manifestations like fever or weight loss. The personal and medical histories of the patient were waldeyyer. Clinical examination revealed a large diffuse extra oral swelling over the right middle and lower third of face.
The swelling appeared tense with no secondary changes. There was local rise in temperature and tenderness on palpation. Swelling was firm in consistency and non-fluctuant. The regional lymph nodes were not amenable to examination due wxldeyer the extensive swelling. Intra oral examination revealed diffuse swelling of right buccal mucosa, vestibule, and retromolar region.
The teeth in the vicinity of the swelling were moderately carious and mobile prompting a clinical diagnosis of odontogenic space anilpo. However the rapidity, the exaggerated nature of the complaint and its unresponsiveness to conventional therapy induced an impression of an aggressive lesion probably a malignancy and encouraged further investigations. Panoramic radiograph showed an irregular massive osteolytic lesion occupying the entire body and ramus of mandible extending up to the condyle on the right side.
Computed tomography confirmed the radiographic findings. Haematological investigations provided values within normal limits. Fine needle aspiration cytology depicted atypical large lymphoid cells in a background of scattered eosinophils.
Metástasis cutáneas en linfoma primario testicular | Actas Dermo-Sifiliográficas (English Edition)
Incisional biopsy showed diffuse sheets of lymphoid cells with large vesicular nuclei and prominent nucleoli. There was evidence of increased mitotic activity and areas of necrosis.
On immunohistochemical analysis, the tumor cells were diffusely positive for Leukocyte Common Antigen CD Metastatic workup revealed no evidence of secondaries. Patient was referred to a regional oncology centre where six complete cycles of standard regimen of CHOP Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone were instituted. Almost complete resolution dde the swelling was noted as early as the end of 3 rd cycle of chemotherapy. The oral cavity is involved in only about 0.
The exact aetiology of lymphomas is unknown. A genetic predisposition, immunodeficiency states like HIV infection or transplant recipients and chromosomal translocation have been implicated in their occurrence .
They arise in the medullary cavity of the bone without involvement of regional lymph nodes or visceral organ over a walddeyer of six months [11,12]. Such tumours are histologically similar to primary nodal lymphomas . In the craniofacial region, the jaws are a frequent site for osseous lymphomas, the maxilla more often involved than the mandible [10, 14, 15].
Bony lymphomas occur over a wide age range, spanning from age years [2, 16]. They are rare in infants and children and have a tendency to involve older adults.
The gender distribution is variable with assorted studies quoting variable male to female ratio ranging linfoka 1. An inverse ratio of 1: The present case is one such rare presentation on NHL affecting the bone primarily without linnfoma the lymph nodes or other visceral organs in an 80 yrs old female patient.
Clinically, lymphomas of the jaws present as a local swelling with dull or aching pain in the bone. Intraorally, they may present as a soft tissue palpable mass . Most of these features mimic common benign or inflammatory conditions of the oral cavity and can be misleading as evident in the current case.
Our patient was staged as I E A, i. Others show sclerotic or mixed radiographic appearance. Large extra osseous soft tissue masses with minimal cortical destruction can be observed on plain radiographs . Loss of cortical definition of the inferior alveolar canal, widening of the canal and the mental foramen, loss of lamina dura and widening of the periodontal ligament space have been observed specifically on panoramic and intra oral radiographs [22,30,31].
Computed tomography and Magnetic resonance imaging help in clear visualization of these changes as well as pattern of trabecular bone destruction and marrow replacement that are usually characteristic of aggressive tumours . Our patient presented with extensive osteolytic lesion involving almost the entire right ramus of the mandible extending into part of the body of the mandible. CT imaging waleyer the lesion helped us in clear delineation of the lesion and a lucid visualization of the internal architecture.
Such an aggressive radiographic appearance shifted our judgment towards a more grave pathological condition. Majority of Lymphomas originate from B-cell lineage. They can present in lymph nodes or in extra nodal sites and can produce extensive destruction of the bones in which they occur.
Histologically they present with sheets of large lymphoid cells with large nuclei which can be cleaved in some cases. Abundant cytoplasm, which is pale walddeyer basophilic and germinal centre formation, can be seen in some lesions . This classification is based only on histopathological and immunohistochemical features . Diagnosis of osseous lymphomas is based on clinical, radiographic and histopathological findings. Abdominal scans, PET scans, laboratory tests like complete hemogram, lactate dehydrogenase, urine analysis, bone marrow aspiration biopsies and advanced immunohistochemistry techniques play a major role in the diagnostic work up and securing an unerring diagnosis .
Characteristic histological features including immunohistochemistry coupled with exaggerated clinical and radiological findings were invaluable in acquiring a diagnosis in the current case although other investigations did not divulge any abnormalities. Chemotherapy and radiotherapy, used alone or in combination are the major modes of treatment . Combination therapy is known to provide a superior outcome when compared to single therapy [38, 39].
Primary lymphoma of bone has excellent prognosis, more so in stage I and with combination therapy [2, 33]. Excellent response was achieved with CHOP chemotherapy regimen alone in the present case.
The patient is under follow up and no recurrence has been noted till date. Advanced understanding of the disease, timely diagnosis, and precise treatment are indispensable in preventing fatal outcomes and promoting a healthy living of those involved. Extra oral photograph showing massive swelling over right side of the face Figure 2.
Orthopantomograph showing extensive osteolytic lesion on the right side of mandible. Article in edited book – Hematologic Disorders. Oral and Maxillofacial Pathology, 3rd edition.
Linfomas primarios del anillo de Waldeyer
Elsevier;p 2. J Oral Maxillofac Surg ; Clinicopathological features and prognostic factors in extra nodal non-Hodgkin lymphomas. Eur J Cancer ; Occurrence and prognosis of extra nodal lymphomas.
Int J Anilo ; A survey of a population-based registry. Eur J Cancer Clin Oncol ; Primary extra-nodal non-Hodgkin’s lymphoma of the cheek. J of Postgraduate med ; 46 3: Lymphoproliferative disease of the hard palate: Malignant lymphoma of the oral cavity: Clinicopathologic analysis of 20 cases.
J Oral Pathol ; 6: Primary lymphoma of the mandible: Malignant lymphoma so called reticulum cell sarcoma of bone.
Primary lymphoma of bone: A B cell neoplasm with a high frequency of multilobated cell. Am J Surg Pathol ; 4: Article in edited book – Huvos AG. Diagnosis, Treatment and Prognosis ed 2. Dee, PA, Saunders ; Article in edited book – Henry K.
Anel linfático de Waldeyer
Neoplastic disorders of lymphoreticular tissue. Systemic Pathology ed 2. Edinburgh, Scotland, Churchill Livingstone ; p Primary lymphoma of the mandible. Head Neck Surg ; 8: Malignant lymphoma of bone. Lihfoma and radiologic features with clinical correlates. Journal article – Potdar GG.
Primary reticulum-cell sarcoma of bone in Western India.