NON-HODGKIN LYMPHOMA OF LOWER LIP: A RARE CASE REPORT
Authors:
RD. Aslam1, P. Pitros2, E. Besi3
Affiliation:
1 Dental Core Trainee in Oral Surgery, Edinburgh Dental Institute
2 Specialty Doctor in Oral Surgery, Edinburgh Dental Institute
3 Senior Clinical Lecturer/Honorary Consultant in Oral Surgery, QMUL Barts and the London school of Medicine and Dentistry
Doi: 10.54936/haoms242p33
ABSTRACT:
Objectives: Mucosa associated lymphoid tissue (MALT)/Extra nodal marginal zone lymphoma is a slow growing non-Hodgkin Beta cell lymphoma. It accounts for approximately 7-8% of non- Hodgkin lymphomas and has a predisposition in females older than 50-60 years. It can affect sites such as the stomach or salivary glands. It’s commonly associated with autoimmune conditions such as Sjogren’s syndrome. This lymphoma generally remains localised and has a low rate of systemic involvement. Treatment is based on the site and stage of the disease. This can involve local therapy; surgery, radiotherapy, or systemic therapy; watch and wait, immunotherapy, chemotherapy.
Material and methods: A 40-year-old, fit and healthy male with no history of smoking was referred to the oral surgery department regarding a 6-month history of a lump on the lower labial mucosa. Clinical examination revealed a 1x1cm raised well defined swelling, soft and mobile in consistency with normal overlying mucosa. Differential diagnosis included mucocele or polyp. After discussion, it was decided to keep under a 3-monthly review. At review, although the clinical appearance remained the same, options were re-discussed, and excisional biopsy was chosen.
Results: Histopathology revealed an extra nodal marginal zone lymphoma. An urgent referral to haematology was completed with request of CT head, neck, chest, abdomen, and pelvis with contrast. CT results were negative. A multi-disciplinary team meeting concluded a watch and wait plan.
Conclusion: MALT lymphomas of the lower lip are rare, with mucoceles common. Following this case, we have adopted a new protocol in the oral surgery department. Lesions which are kept under observation will have clinical photos with ultrasound assessment. Outcome of this rare case was “positive”. However, having had the ultrasound we could have diagnosed it sooner. It is important to reiterate to patients that without special investigations a definitive diagnosis cannot be achieved.
KEY WORDS: Non-Hodgkins Lymphoma, MALT Lymphoma, Oral Surgery
Authors:
RD. Aslam1, P. Pitros2, E. Besi3
Affiliation:
1 Dental Core Trainee in Oral Surgery, Edinburgh Dental Institute
2 Specialty Doctor in Oral Surgery, Edinburgh Dental Institute
3 Senior Clinical Lecturer/Honorary Consultant in Oral Surgery, QMUL Barts and the London school of Medicine and Dentistry
Doi: 10.54936/haoms242p33
ABSTRACT:
Objectives: Mucosa associated lymphoid tissue (MALT)/Extra nodal marginal zone lymphoma is a slow growing non-Hodgkin Beta cell lymphoma. It accounts for approximately 7-8% of non- Hodgkin lymphomas and has a predisposition in females older than 50-60 years. It can affect sites such as the stomach or salivary glands. It’s commonly associated with autoimmune conditions such as Sjogren’s syndrome. This lymphoma generally remains localised and has a low rate of systemic involvement. Treatment is based on the site and stage of the disease. This can involve local therapy; surgery, radiotherapy, or systemic therapy; watch and wait, immunotherapy, chemotherapy.
Material and methods: A 40-year-old, fit and healthy male with no history of smoking was referred to the oral surgery department regarding a 6-month history of a lump on the lower labial mucosa. Clinical examination revealed a 1x1cm raised well defined swelling, soft and mobile in consistency with normal overlying mucosa. Differential diagnosis included mucocele or polyp. After discussion, it was decided to keep under a 3-monthly review. At review, although the clinical appearance remained the same, options were re-discussed, and excisional biopsy was chosen.
Results: Histopathology revealed an extra nodal marginal zone lymphoma. An urgent referral to haematology was completed with request of CT head, neck, chest, abdomen, and pelvis with contrast. CT results were negative. A multi-disciplinary team meeting concluded a watch and wait plan.
Conclusion: MALT lymphomas of the lower lip are rare, with mucoceles common. Following this case, we have adopted a new protocol in the oral surgery department. Lesions which are kept under observation will have clinical photos with ultrasound assessment. Outcome of this rare case was “positive”. However, having had the ultrasound we could have diagnosed it sooner. It is important to reiterate to patients that without special investigations a definitive diagnosis cannot be achieved.
KEY WORDS: Non-Hodgkins Lymphoma, MALT Lymphoma, Oral Surgery