The head and neck is the second most common region for extranodal lymphomas after the gastrointestinal tract for NHL 5,6. Waldeyer’s ring, which is an area encompassed by the nasopharynx, tonsil and the base of the tongue, is the most common area of malignant lymphoma involvement. The tonsil is the most frequent site, followed by the nasopharynx 7,8. NHL arising within the oral cavity accounts for less than 5% of all oral malignancies, and ∼85% of the lesions involve the tonsils and the palate. Gingiva forms one of the rarest extranodal sites (0.44%). Diffuse large B-cell lymphoma is composed of large transformed B cells with immunoblastic features, which may develop in both children and adults. The majority of reported cases have the B-cell phenotype. The T-cell phenotype is much more likely for sinonasal than oropharyngeal lymphoma 9–12. Usually, lymphoma presents in the oral cavity as the first identifiable evidence of the disease 13,14. Sometimes, these may also present as squamous cell carcinoma and needs to be considered in the differential diagnosis 15. There is considerable evidence that lymphomas at specific sites show a local inflammatory process in the beginning, followed by an increased rate of cell division of lymphocytes, thereby increasing the risk of development of a malignant clone 2.
The prevalence of NHL is increasing among those who are immunocompromised, have received organ transplants and those with autoimmune disorders such as Sjögren’s syndrome or rheumatoid arthritis. An increased incidence of NHL has also been found in patients with AIDS13, and oral lesions of NHL are the first manifestation of AIDS 2.
In the present case, a gingival lesion was the only manifestation. Blood chemistry and radiographs were normal. The oral lesion revealed NHL and proper institution of the treatment helped in the regression of the disease.
Although NHL involving the oral region is uncommon, it should be considered in the differential diagnosis of malignant lesions in this area, because treatment and prognoses for these conditions are quite different. A proper clinical evaluation, in addition to a histopathologic as well as immunohistochemical evaluation of the biopsy specimen, is necessary for the correct diagnosis and will aid proper management.
There are no conflicts of interest.
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