Primary non-Hodgkin’s lymphoma of the mandibular gingiva with maxillary gingival recurrence

Abstract

Primary (extranodal) non-Hodgkin’s lymphoma (NHL) of the oral cavity is relatively rare. We report a case of NHL involving the left anterior mandibular gingiva of a 56-year-old man. He was initially treated with antibiotics and root canal therapy of the lower lateral incisor as there was a history of trauma to this area. The adjacent lateral incisor tested non-vital. However, after 2 weeks of antibiotic therapy the swelling increased in size and an incisional biopsy was performed. A diagnosis of non-Hodgkin’s lymphoma, large-B cell type was rendered. The patient was then referred to medical oncology for staging work-up and treatment. A course of six cycles of CHOP chemotherapy (Cyclophosphamide, Hydroxydoxorubicin, Oncovin, Prednisone) and radiotherapy were scheduled. There was a complete response upon completion of the combined chemotherapy and radiotherapy. One year later, the patient developed a 2 × 2-cm, painless, firm, fixed mass of the left anterior maxillary vestibule. No additional findings were noted clinically. Magnetic resonance imaging (MRI) confirmed the clinical findings and there was no suspicion of disease elsewhere. Pathologic examination revealed non-Hodgkin’s lymphoma, B-cell type. This lesion was identical morphologically and immunophenotypically to the initial mandibular lesion. Complete radiographic staging detected no other sites of disease. The bone marrow was not involved. The lesion rapidly normalized after six cycles of Fludara, Novantrone and Mabthera chemotherapy and one cycle of Cytarabine (Ara-C). Partial remission was achieved, but the patient died of disseminated disease, 12 months after relapse. There was an associated HCV infection, which may have played a role in the fatal outcome.