Fuessinger Marc Anton, Voss Pit, Metzger Marc Christian, Zegpi Claudia, Semper-Hogg Wiebke
Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Freiburg 79106, Germany.
Faculty of Dentistry University of Chile, Santiago, Chile.
Ann Maxillofac Surg. 2018 Jan-Jun;8(1):143-146. doi: 10.4103/ams.ams_163_17.
Malignant lymphomas are about 5% of all malignant tumors. Extranodal non-Hodgkin's lymphomas (NHLs) are found in 26% of these cases. Lymphomas of the head-and-neck area occur in 2%-3% of all malignancies, with 28% with an extranodal manifestation. Extranodal NHLs in the oral cavity are usually found in the maxilla, and rarely in the mandible. Their symptoms and clinical manifestation have no pathognomonic features; therefore, the expression of this uncommon entity can be diagnosed with an odontogenic inflammatory process, leading to a misdiagnosis. Delay in the decision for a biopsy, and adequate treatment for the patient directly impairs the prognosis of this neoplasm. This study reports a case of a patient with discomfort in the right mandible and paresthesia of the right lower lip and chin without any dental focus. After performing further diagnostic examinations including a subsequent biopsy, the final diagnosis was a diffuse large B-cell lymphoma (DLBCL). Intraosseous DLBCLs are uncommon in the daily clinical routine, but emphasize the need for careful examination by the clinicians also considering the differential diagnosis of sensory neuropathy. Neurological symptoms with no apparent cause should raise the suspicion of malignancy until the opposite is proven.
恶性淋巴瘤约占所有恶性肿瘤的5%。其中26%为结外非霍奇金淋巴瘤（NHL）。头颈部淋巴瘤占所有恶性肿瘤的2% - 3%，其中28%有结外表现。口腔内的结外NHL通常发生在上颌骨，很少发生在下颌骨。其症状和临床表现没有特征性表现；因此，这种不常见的疾病表现可能被诊断为牙源性炎症过程，从而导致误诊。活检决策的延迟以及对患者的适当治疗直接影响该肿瘤的预后。本研究报告了一例患者，其右下颌不适，右下唇和下巴感觉异常，无任何牙齿病灶。在进行包括后续活检在内的进一步诊断检查后，最终诊断为弥漫性大B细胞淋巴瘤（DLBCL）。骨内DLBCL在日常临床实践中并不常见，但强调临床医生需要仔细检查，同时也要考虑感觉神经病变的鉴别诊断。无明显原因的神经症状应引起对恶性肿瘤的怀疑，除非能排除。
