Clinical Analysis Of Non-Hodgkin's Lymphoma Presenting In Oral & Maxillofacial Region

Objective: Non-hodgkin's lymphoma (NHL) refers to a group of malignant neoplasms that arise from cellular elements of lymphoid or extranodal tissue. Lymphomas are a frequent cause of malignant lymphadenopathy in the head &neck. The head &neck is the second must frequent anatomical site of extranodal lymphomas after gastrointestinal tract. That's why dental & maxillofacial surgeon should be aware of malignant lymphoma to diagnose properly & efficiently. This study was performed to evaluate oral & maxillofacial region manifestations, staging, grading and prognosis of NHL.Materials & Method: A retrospective analysis or review of 25patients with oral &maxillofacial region lymphoma was made in our hospital (Dalian Medical University, Stomatology Department of First Affiliated hospital) from 2002jan to 2006 august .Specifically, clinical presentation, staging, grading & therapy for NHL with oral &maxillofacial region involvement were sought. Staging was done according to the Ann Arbor staging system and diagnosis made by immunohistochemistry.Result: 25 patients of NHL were included in our study, among them 20(80%) patients with extra nodal (eNHL) &5(20%) patients with nodal (NHL) involvement. The incidence rate increases exponentially with age between 24 and 79 years. The median age at the diagnosis of the patients was 60yrs.Patients above 50 years were 72%.Male (60%) is slightly more than female (40%). Among 20 patients, NHL of Waldeyer's ring was the most frequent site occurring in 10 patients (50%) followed by NHL of oral cavity (20%), of salivary glands (30%). Constitutional B symptomatology was uncommon, occurring in 25% patients. The typical clinical appearance is a painless local mass lateral or bilateral (90%) and confused with squamous cell carcinoma. Most of the non-Hodgkin's lymphoma was B-cell lineage (90%), & overall diffuse large B-cell lymphoma (76%) was the most common type. Mostly patients involving non-Hodgkin's lymphoma in oral &maxillofacial region were 64%stageI&II (stage I(40%), stageII (24%), stageIII (20%) &stage IV(16%)) and (84%) intermediate /high grade. Among these patients, two were died (mostly older aged with stage IV) and remission in 6 patients after one year.Conclusion: The NHL present in oral and maxillofacial region is generally in older patients (logarithmic increase with age in non-Hodgkin's lymphoma). Male is more common than female. Favorable site is 1st tonsil, 2nd salivary gland & 3rd oral cavity .The typical clinical appearance is a painless local mass lateral or bilateral. Often there is a superficial ulceration of the tumor mass which confused with squamous cell carcinoma. constitutional B symptoms (This type is characterized by unexplained, persistent or recurrent fever with temperature higher than 38°C or by recurrent and drenching night sweats within 1 month, or by unexplained loss of more than 10% the person's body weight within 6 months.) are uncommon in non-Hodgkin's disease. B-cell lineage and diffuse large B-cell are mostly predominant. Mostly non-Hodgkin's lymphoma presenting in oral &maxillofacial region were intermediate / high. The prognosis of NHL is depending upon the site, stage & histological grade. It is important for the oral maxillofacial surgeon & dentists to be aware of the various clinical manifestations of NHL of the oral cavity & oral maxillofacial region to diagnose this malignant disease quickly &appropriately. NHL of oral &maxillofacial region if discovered early has an excellent prognosis. Obviously, lymphoma should be part of the differential diagnosis in any head and neck lesions including the oral cavity & maxillofacial region.