Lymphoma

Etiology • Idiopathic • Long-term immunosuppression • ?Post radiation
Clinical Presentation • Relatively common in head and neck region • Most common in middle-aged and older individuals • Mass of reddish blue tissue with ulceration, pain • Paresthesia of lip when occurring in mandible • Initial presentation in oral cavity is uncommon (2%) • Predominant oral sites: palate, gingiva, buccal mucosa, mandible • May arise within lymph nodes or extranodally in soft tissue • Ill-defined radiolucency in bone • Hodgkin’s lymphoma rare in oral cavity • Burkitt’s lymphoma arises in children.

Microscopic Findings • Non-Hodgkin’s lymphoma predominates; almost always
B cell type • Varied, depending upon type/subtype: cell size, pattern, matu-
ration level • Classification schemes dependent upon microscopic features • Human immunodeficiency virus–associated lymphomas are
typically diffuse, large cell, high-grade lymphomas. • EB virus is often evident in tumor cells.
• Revised European American Lymphoma Classification and Working Formulation are current microscopic classifications
Diagnosis • Biopsy, immunohistochemical studies • Flow cytometry • Staging work-up involves the following:
• Bone marrow biopsy • Whole body computed tomography scan
Differential Diagnosis • Salivary neoplasm • Metastatic tumor • Soft tissue tumor (primary) • Leukemia
Lymphoid Lesions 223
Treatment • Dependent upon extent/clinical stage and microscopic features • For localized (stage I) disease: radiation therapy • Chemotherapy or combined chemotherapy-radiation therapy
for more widespread disease • Very-low-grade lesions may be observed only since treatment
typically has no effect on outcome. Prognosis
• Dependent upon clinical stage and histologic subtype; acquired immunodeficiency syndrome–associated lymphoma has a poor outcome
• Very-low-grade lesions have excellent prognosi