State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, 610041, Chengdu, China.
Department of Pathology, West China Hospital, Sichuan University, Chengdu, 610041, China.
BMC Oral Health. 2022 Nov 19;22(1):514. doi: 10.1186/s12903-022-02567-7.
Erosion is one of the most common and basic lesions of oral mucosal diseases. Long-term refractory oral erosions, induced by autoimmune blistering diseases, infectious diseases, malignant diseases, and some rare conditions, may substantially reduce the quality of life of patients or even constitute a life-threatening condition, resulting in a clinical dilemma regarding the accurate diagnosis and precise management of these diseases. As a special type of malignant lymphoma, most lesions of follicular lymphoma (FL) in the oral mucosa present as masses or swelling of the oral mucosa, while emerging novel presentations lead to intractable diagnoses. Hence, diagnostic algorithms for such diseases are clinically required. CASE PRESENTATION: A 55-year-old female patient presented to the clinic with long-lasting oral mucosal erosions and proliferative lesions. Blood tests, pathological examinations of oral lesions including haematoxylin-eosin (HE) staining, and direct immunofluorescence precluded all of the potential diagnoses described previously. Unexpectedly, positron emission tomography/computed tomography (PET/CT) and abdominal CT of the patient revealed a dense mass in the retroperitoneal area, and the final diagnosis of the retroperitoneal mass was FL. After three courses of chemotherapy conducted by the haematologist, the erosion and proliferative lesions in the patient's oral mucosa had significantly improved. HE and immunohistochemical staining results of intraoral lesions also confirmed it as oral FL. The successful diagnosis of FL in this case is of great clinical significance, as the oral and abdominal FL were treated in a timely manner to avoid unfavourable outcomes.
To the best of our knowledge, this is the first case of FL that exhibited widespread erosions interspersed with proliferative lesions. Clinicians should be aware of oral FL or seek systemic factors in the presence of similar refractory oral erosions when treatment is non-responsive and the diagnosis is intractable.
侵蚀是口腔黏膜疾病中最常见和最基本的病变之一。由自身免疫性疱病、传染病、恶性肿瘤和一些罕见情况引起的长期难治性口腔侵蚀可能会显著降低患者的生活质量，甚至构成危及生命的情况，导致这些疾病的准确诊断和精确管理出现临床困境。作为一种特殊类型的恶性淋巴瘤，大多数口腔黏膜滤泡性淋巴瘤（FL）病变表现为口腔黏膜肿块或肿胀，而新出现的病变导致难以诊断。因此，临床上需要此类疾病的诊断算法。
一名 55 岁女性患者因长期口腔黏膜侵蚀和增生性病变就诊。血液检查、口腔病变的组织病理学检查（包括苏木精-伊红（HE）染色）和直接免疫荧光检查排除了之前描述的所有潜在诊断。出乎意料的是，患者的正电子发射断层扫描/计算机断层扫描（PET/CT）和腹部 CT 显示腹膜后区域有一个致密肿块，最终诊断为腹膜后肿块 FL。经过血液科的三个疗程化疗后，患者口腔黏膜的侵蚀和增生性病变明显改善。口腔病变的 HE 和免疫组织化学染色结果也证实为口腔 FL。该病例成功诊断 FL 具有重要的临床意义，因为口腔和腹部 FL 得到了及时治疗，避免了不良结局。
据我们所知，这是首例表现为广泛侵蚀伴增生性病变的 FL 病例。当治疗无效且诊断困难时，临床医生应注意口腔 FL 或在存在类似难治性口腔侵蚀时寻找系统性因素。
