Hanemann João Adolfo Costa, de Carli Marina Lara, Dendena Ernesto Rabello, do Couto Filho Carlos Eduardo Gomes, de Sousa Suzana Catanhede Orsini Machado, Pereira Alessandro Antônio Costa, Giudice Fernanda Salgueiredo, Sperandio Felipe Fornias
Department of Clinic and Surgery, School of Dentistry, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700, Alfenas, MG, 37130-001, Brazil.
Department of Head and Neck Surgery, Bom Pastor Hospital, Rua Pres. Tancredo Neves, 500, Varginha, MG, 37014-460, Brazil.
Oral Maxillofac Surg. 2017 Dec;21(4):475-481. doi: 10.1007/s10006-017-0661-y. Epub 2017 Oct 25.
Follicular lymphoid hyperplasia is a very rare though benign reactive process of an unknown pathogenesis that may resemble a follicular lymphoma, clinically and histologically. Oral reactive follicular hyperplasia (RFH) has been described on the hard or soft palate and at the base of the tongue. We describe here the first case of RFH presenting as an aggressive tumor on the right posterior side of the maxilla in a 24-year-old male patient. The lesion had a clinical evolution of 18 months and was noticed after the surgical extraction of the right third molar, although we cannot assume a cause-effect relation with that surgical event whatsoever. His medical history was unremarkable. Following an incisional biopsy, histological examination revealed lymphoid follicles comprised by germinal centers surrounded by well-defined mantle zones. The germinal centers were positive for Bcl-6, CD10, CD20, CD21, CD23, CD79a, and Ki-67, while negative for Bcl-2, CD2, CD3, CD5, and CD138. The mantle and interfollicular zones were positive for Bcl-2, CD2, CD3, CD5, CD20, and CD138. Both areas were diffusively positive for kappa and lambda, showing polyclonality. The patient underwent a vigorous curettage of the lesion with no reoccurrences at 36 months of follow-up. This case report demonstrates that morphologic and immunohistochemical analyses are crucial to differentiate RFH from follicular lymphoma, leading to proper management.
滤泡性淋巴组织增生是一种非常罕见的良性反应性过程，其发病机制不明，在临床和组织学上可能类似于滤泡性淋巴瘤。口腔反应性滤泡性增生（RFH）已被描述于硬腭或软腭以及舌根处。我们在此报告首例RFH，表现为一名24岁男性患者上颌右侧的侵袭性肿瘤。该病变有18个月的临床病程，在拔除右侧第三磨牙后被发现，尽管我们不能认为与该手术事件有任何因果关系。他的病史无异常。切开活检后，组织学检查显示淋巴滤泡由生发中心组成，周围有界限清晰的套区。生发中心Bcl-6、CD10、CD20、CD21、CD23；CD79a和Ki-67呈阳性，而Bcl-2、CD2、CD3、CD5和CD138呈阴性。套区和滤泡间区Bcl-2、CD2、CD3、CD5、CD20和CD138呈阳性。两个区域kappa和lambda均弥漫性阳性，显示多克隆性。该患者对病变进行了积极的刮除术，随访36个月无复发。本病例报告表明，形态学和免疫组化分析对于区分RFH和滤泡性淋巴瘤至关重要，从而能进行恰当的处理。
