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Lymphoma is a malignant neoplasm of the lymphoid tissue and represents one of the most common hematologic malignancies affecting the head and neck region. Because lymphomas frequently present in cervical lymph nodes, Waldeyer’s ring, and oral soft tissues, dental professionals play a critical role in early detection. Oral lymphomas may mimic inflammatory, infectious, or reactive conditions, leading to diagnostic delay.
Overview and Classification
Lymphomas are broadly classified into:
- Hodgkin Lymphoma (HL)
- Non-Hodgkin Lymphoma (NHL)
The distinction is based on histopathologic and immunophenotypic features, particularly the presence or absence of Reed–Sternberg cells.
Epidemiology and Etiology
General
- Lymphoma is the second most common malignancy of the head and neck after squamous cell carcinoma
- Can occur at any age
- Etiology involves genetic, immunologic, and infectious factors
Risk Factors
- Immunosuppression (HIV/AIDS, transplant patients)
- Autoimmune diseases
- Epstein–Barr virus (EBV) infection
- Helicobacter pylori (gastric MALT lymphoma)
- Environmental exposures
Hodgkin Lymphoma (HL)
Definition and Pathogenesis
Hodgkin lymphoma is a B-cell malignancy characterized by the presence of Reed–Sternberg (RS) cells, which are large atypical lymphoid cells with bilobed nuclei and prominent nucleoli.
Epidemiology
- Bimodal age distribution (young adults and older adults)- Slight male predominance
- Oral involvement is rare
Common Sites
- Cervical lymph nodes- Mediastinum
- Waldeyer’s ring (rare oral involvement)
Clinical Features
- Painless lymphadenopathy- “B symptoms”: fever, night sweats, weight loss
- Fatigue and pruritus
- Oral lesions are uncommon and usually secondary
Histopathology
- Presence of Reed–Sternberg cells- Mixed inflammatory background
= Nodular sclerosis
= Mixed cellularity
= Lymphocyte-rich
= Lymphocyte-depleted
Immunohistochemistry
- RS cells: CD15 positive, CD30 positivePrognosis
- Generally favorable
- High cure rates with modern therapy
Non-Hodgkin Lymphoma (NHL)
Definition and Pathogenesis
Non-Hodgkin lymphoma comprises a heterogeneous group of lymphoid malignancies derived from B cells, T cells, or NK cells. NHL is far more likely than HL to involve extranodal sites, including the oral cavity.
Epidemiology
- More common than HL- Incidence increases with age
- Strong association with immunosuppression
Common Oral and Maxillofacial Sites
- Waldeyer’s ring (tonsils, base of tongue)Clinical Presentation
- Non-tender, firm swelling- Ulceration or mucosal erythema
- Tooth mobility or non-healing extraction sockets
- Paresthesia (“numb chin syndrome”)
- Cervical lymphadenopathy
Oral NHL often mimics periodontal disease or odontogenic infection.
Common Oral NHL Subtypes
- Diffuse large B-cell lymphoma (DLBCL) – most commonPathology
Histopathological Features
- Diffuse or nodular proliferation of atypical lymphoid cells- Loss of normal lymph node architecture
- High mitotic activity in aggressive types
Immunohistochemistry
Used to confirm lineage and subtype:
- B-cell markers: CD20, CD79a- T-cell markers: CD3
- Ki-67 proliferation index helps determine aggressiveness
Imaging Characteristics
- Radiographs may show ill-defined radiolucency in jaw lesions- CT and MRI demonstrate soft tissue mass and bone involvement
- PET-CT used for staging and treatment monitoring
Diagnosis
Definitive diagnosis requires:
- Incisional or excisional biopsy- Histopathologic examination
- Immunophenotyping
- Systemic staging
Fine-needle aspiration alone is usually insufficient.
Treatment Principles
Hodgkin Lymphoma
- Combination chemotherapy- Radiotherapy in selected cases
- Excellent response rates
Non-Hodgkin Lymphoma
- Treatment depends on subtype and stage- Chemotherapy ± immunotherapy (e.g., rituximab)
- Radiotherapy for localized disease
- Surgery is not primary treatment
Prognostic Factors
- Lymphoma subtype- Disease stage
- Patient age and immune status
- Tumor proliferation index
- Response to therapy
HL generally has a better prognosis than aggressive NHL.
Role of Dental Professionals
Dental professionals are critical in early recognition:
- Investigate unexplained oral swellings or ulcerations- Be alert to rapid tissue enlargement without infection
- Biopsy suspicious lesions promptly
- Manage oral complications of chemotherapy and radiotherapy
- Provide long-term oral care and surveillance
Conclusion
Lymphoma is a significant malignancy with frequent head and neck involvement. Non-Hodgkin lymphoma, in particular, often presents in the oral cavity and may mimic common dental conditions. Early detection by dental professionals, combined with prompt biopsy and referral, plays a vital role in improving patient outcomes.