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Thứ Ba, 27 tháng 3, 2018


Trong số 20 ca lymphom lan tỏa dòng tế bào B lớn [diffuse large B cell lymphoma] ở Trung tâm Y khoa Medic từ 2008,  có 03 ca có triệu chứng đau răng và hàm mặt điều trị giảm đau, nhổ răng..không bớt, sau đó xuất hiện nhiều tổn thương khác ngoài hạch. Trong khi đó, tìm được một bài báo về đau xương hàm dưới trong lymphom ác. Sau đây là một hồi cứu về đề tài này.

             Diffuse Large B Cell Lymphoma
and Appearences  in Oral Cavity, and Maxillary Area
Nguyen Thien Hung, Jasmine DCB Thanh Xuan, Le van Tai, Le Thong Nhat, Le Thanh Liem, Phan Thanh Hai
Medic Medical Center, HCMC, Vietnam

May there had been an initial symptom in oral cavity, maxillary and mandibular area for diffuse infiltration of lymphoma?  We will represent some cases of diffuse lymphoma with appearences  in oral cavity,  and maxillary areas.

We retrospectively reviewed  20 cases of diffuse lymphoma that were histopathologically diagnosed in our center from 2008 in which presented 03 cases  with oral cavity,  maxillary symptoms and  bone involvement [01 case in male 42 yo and 02 cases in female gender, 33 and 40 year-old].


CASE 1= A 33 year-old female patient with pain in lower maxillary bone for one month and tension in both  2 breats), hyperpigmented edema of areolar area both 2 sides without pregnancy.  ABVS scanning  detected  multiple nodules infiltrating in 2 breasts.
Biopsy of 2 breasts  reported  microscopic with immunohistochemistry scanning, diffuse large B cell lymphoma.
MRI  full body with gado detected  bone marrow changing, 2 breats  hypercaptured contrast,  ascites and kidney infiltration. In pelvis  2 ovarian tumors and big uterine cervix were detected. Blood tests showed   lower platelets,  EGFR  lower  46, beta2 microglobuline raised  3816,  ferritin raised  911, LDH-l  raised  1360.

CASE 2= A 40 year-old female patient with toothache but pain remained  after removing tooth, and in total body examination detected right pleural effusion  and some nodular tumors in thyroid, left breast and subcutaneous area of right neck, left chest all and  lumbar region. Erosions of left clavicle and right 1st rib. Biopsy of left breast tumor reported diffuse large B cell lymphoma.

CASE 3= Man 42 year-old, one month ago, pain in oral sinus, difficult eating and 2 days after,  pain appears in left testis. Ultrasound of left big and  hot testis represented  hypoechoic  infiltration,  hypervascular of one part of testis and elastoscan ultrasound value #  10.5 kPa).
 FNAC of this mass of left testis  having abnormal cells. Biopsy of  tumor in oral area represented diffuse large  B cell lymphoma.

There are published reports of pain in mandibular area as initial symptom but symptoms in oral cavity and maxillary bone as onset symptom seems to be not represented in literature. But it exists a case of pain in oral cavity for lymphoma infiltrating in testis and an another case of pain in maxillary area for lymphoma in whole body in this report.Toothache and pain in maxillary region remained with management guided a survey in all body and detected extranodal lesions: bone erosions, perirenal edema, ovarian, uterine cervix, testicular edema, subcutaneous nodules. But in literature, only mandibular lesion with tooth pain were published which not included.

Seveval  reports of lymphoma in mandible were published with pain as initial symptom,  but in cases of diffuse infiltration of lymphoma in whole body, the appearences in oral cavity, maxillary and mandibular areas with pain symptom may be added criteria of diagnosis for lymphoma in clinical examination.


 Mochizuki, Y.,  Harada, H.,  Sakamoto, K.,  Kayamori,  K.,  Nakamura,  S.,  Ikuta, M.,  Kabasawa, Y., Marukawa, E., Shimamoto, H., Tushima, F. and Omura, K. (2015) Malignant Lymphoma with Initial Symptoms in the Mandibular Region. Journal of Cancer Therapy, 6, 554-565

Primary intraosseous lymphoma is rare and there are few case reports manifesting with a mass in the mandible. Thus, we retrospectively reviewed and analyzed the clinical characteristics,  treatment, and outcome of extranodal non-Hodgkin’s lymphoma (NHL) with initial mandibular symptoms in our department. At initial treatment of dental clinics, dentists had diagnosed as dental or gingival diseases and had performed dental treatment. Neurological disorder to involvement of the inferior alveolar nerve was present in 80.0% of our cases. On dental or panoramic radiography a specific radiolucent lesion in the mandible was not detected, except for dental lesions. On CT, NHL of the mandible region has no widening and no clear destruction but a slit-like the cortex bone destruction pattern with keeping in shape of the mandibular body  (62.5% of CT-examined cases), and extraosseous soft tissue mass are clearer on MRI  (100.0% of MRI-examined cases).
Histopathologically, 80.0% of our cases were diagnosed as diffuse large B cell lymphoma (DLBCL).
One case as B-cell lymphoblastic lymphoma and one case as B-cell lymphoma unclassifiable with features intermediate between DLBCL and Burkitt lymphoma were Stage IV  (Ann Arbor staging system) and had poor prognosis. The disease-specific survival rate was 77.8% at 5 years. If unexplained non-specific symptoms such as swelling of the jaw, pain, neurological disorder of the inferior alveolar nerve, tooth mobility are observed, oral surgeons and dentists should not perform
dental treatments. CT and MRI show disease specific appearance to be able to give a definitive diasnosis as NHL. PET/CT is useful for scaninng of whole body. A deep bone biopsy is preferred for
suspected malignant lymphoma.

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