Montaner Sylvain, Weingertner Noelle, Ledoux Marie-Pierre, Chenard Marie-Pierre, Lutz Jean-Christophe, Bornert Fabien
Dental Faculty, University of Strasbourg, 8 rue Sainte Elisabeth, F-67000 Strasbourg, France.
Oral Surgery and Oral Medecine Unit, Dental Clinic, Hopital Civil, University Hospital of Strasbourg, 1 place de l'Hopital, F-67000 Strasbourg, France.
J Hematol. 2018 Jan;7(1):23-28. doi: 10.14740/jh346w. Epub 2017 Jan 10.
Lymphomas represent the second most common malignant lesions of the head and neck. Among them, follicular lymphomas (FLs) are the second most frequent B-cell non-Hodgkin's lymphomas. However, their incidence is rare in the oral cavity. We describe here two cases of FL with initial intra-oral presentation. The first patient was 81 years old and presented a palatal hyperplasia, covering the posterior edge of her dental removable prosthesis. After surgical excision of the lesion, the pathological diagnosis was an extra-nodal low-grade follicular lymphoma. Medical imaging assessment found a widespread but non-bulky involvement. The second patient was 38 years old and referred for asymptomatic swelling of the lower vestibule evolving for 4 months. Surgical exploration revealed a cheek lymphadenopathy infiltrated by a grade 3 FL; this patient did not have any other localization. Both patients were treated by a rituximab monotherapy with excellent response after 2 years of follow-up. Most of the time, FL affecting the oral cavity presenting as unspecific swelling, can mimic other frequent and benign oral lesions. In the absence of biopsy, both diagnosis and proper onco-hematological management may be delayed. The introduction of monoclonal antibody rituximab represents a major advance in the management of FL: it can be used as monotherapy or may be combined with chemo-immunotherapy according to histological grading, initial staging (extent, tumor mass or bulk), age and co-morbidities. These two observations show the importance of an early diagnosis regarding a chronic lesion in the oral cavity. Painless lymphadenopathy, asymptomatic swelling, aspecific mucosal lesions, or subprosthetic lesions should draw attention of any oral specialist.
淋巴瘤是头颈部第二常见的恶性病变。其中，滤泡性淋巴瘤（FL）是第二常见的B细胞非霍奇金淋巴瘤。然而，其在口腔中的发病率很低。我们在此描述两例以口腔内首发的FL病例。首例患者为81岁女性，表现为腭部增生，覆盖其可摘义齿的后缘。病变手术切除后，病理诊断为结外低度滤泡性淋巴瘤。医学影像评估发现病变广泛但无明显肿块。第二例患者为38岁，因下前庭无症状肿胀4个月前来就诊。手术探查发现颊部淋巴结病，为3级FL浸润；该患者无其他部位受累。两名患者均接受利妥昔单抗单药治疗，随访2年后疗效良好。大多数情况下，累及口腔的FL表现为非特异性肿胀，可酷似其他常见的良性口腔病变。若未进行活检，诊断及适当的肿瘤血液学管理可能会延迟。单克隆抗体利妥昔单抗的引入是FL治疗的一项重大进展：根据组织学分级、初始分期（范围、肿瘤大小或肿块）、年龄及合并症情况，它可作为单药治疗，也可与化疗免疫治疗联合使用。这两例观察结果表明，对于口腔慢性病变进行早期诊断非常重要。无痛性淋巴结病、无症状肿胀、非特异性黏膜病变或义齿下病变应引起任何口腔专科医生的注意。
