Hokett S D, Cuenin M F, Peacock M E, Thompson S H, Van Dyke T E
US Army Periodontic Residency, Fort Gordon, GA, USA.
J Periodontol. 2000 Mar;71(3):504-9. doi: 10.1902/jop.2000.71.3.504.
We describe an unusual case of extra-nodal non-Hodgkin's lymphoma that developed in the maxillae associated with localized severe periodontitis in a 64-year-old Caucasian male. The lymphoma was diagnosed less than 2 years following routine periodontal surgery and 8 weeks after the extraction of hopeless teeth in the associated area.
Two months following the extractions, the patient experienced pain and swelling in the maxillary right edentulous area mimicking an abscess, and reported for emergency care. An expansile lesion measuring 2.0 x 2.5 cm in diameter was noted on radiographic examination to extend into the right maxillary sinus. A definitive biopsy diagnosis of high-grade, small, non-cleaved, diffuse non-Hodgkin's lymphoma of the right posterior maxillae was established. The patient was subsequently treated by a combination of radiation, chemotherapy, and bone marrow transplantation.
The maxillary tissues healed uneventfully, and the patient has been closely observed for approximately 5 years without symptoms or recurrence of the lymphoma.
This case highlights the need for careful debridement of extraction sockets associated with severe periodontitis and argues for the routine submission of extracted teeth with adjacent soft tissue for microscopic analysis, to assist in the early diagnosis of potentially life-threatening malignancies.
我们描述了一例罕见的结外非霍奇金淋巴瘤病例，该病例发生在一名64岁白种男性的上颌骨，与局限性严重牙周炎相关。该淋巴瘤在常规牙周手术后不到2年以及相关区域患牙拔除8周后被诊断出来。
拔牙后两个月，患者上颌右侧无牙区出现疼痛和肿胀，类似脓肿，前来急诊。影像学检查发现一个直径为2.0×2.5厘米的膨胀性病变延伸至右上颌窦。最终活检确诊为右后上颌骨高级别、小细胞、非裂细胞、弥漫性非霍奇金淋巴瘤。患者随后接受了放疗、化疗和骨髓移植联合治疗。
上颌组织愈合顺利，患者已被密切观察约5年，无淋巴瘤症状或复发。
该病例强调了对与严重牙周炎相关的拔牙创进行仔细清创的必要性，并主张常规将拔除的牙齿及其相邻软组织送检进行显微镜分析，以协助早期诊断潜在的危及生命的恶性肿瘤。
