Extranodal non-Hodgkin’s lymphoma presented as bilateral enlargement of the mandibular canals: a case report

IF 1.9 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Oral Surgery Oral Medicine Oral Pathology Oral Radiology Pub Date : 2025-07-21 DOI:10.1016/j.oooo.2025.04.041

Rana Alshagroud , Fahad Mutawwam , Ahmed Alhumaidi , Fadi Alakeel , Farjah Algahtani

{"title":"Extranodal non-Hodgkin’s lymphoma presented as bilateral enlargement of the mandibular canals: a case report","authors":"Rana Alshagroud , Fahad Mutawwam , Ahmed Alhumaidi , Fadi Alakeel , Farjah Algahtani","doi":"10.1016/j.oooo.2025.04.041","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>Bilateral enlargement of the mandibular canals (BEMC) is extremely rare and the differential diagnosis includes vascular malformation, benign neural tumors, or localized hypertrophic neuropathy. Extranodal non-Hodgkin’s lymphoma (ENHL) involving the mandibular canals is exceptionally rare with only five cases reported. Herein, we report an interesting case of ENHL presented as BEMCs.</div></div><div><h3>Materials and Methods</h3><div>A 43-year-old Saudi woman came to our oral surgery clinic complaining of heaviness in her mandible for 9 months. The panoramic radiograph revealed a bilateral diffuse uniform thickening of the mandibular canal. MRI showed isolated bilateral thickening and enhancement of mandibular branches of the trigeminal nerves with no involvement to the adjacent structures.</div></div><div><h3>Results</h3><div>An incisional biopsy was performed and microscopic examination showed a diffuse lymphocytic infiltration admixed with few plasma cells in a background of fibrosis. Neoplastic cells were positive for CD20 and PAX5 with Kappa chain restriction. Cyclin D1, IgG4, BCL6, and CD10 were negative. IgH rearrangement was positive for the clonal-B-cell receptor (IGH) gene.</div></div><div><h3>Conclusions</h3><div>We present an extremely unusual case of ENHL expanding the radiographic differential diagnosis of BEMC. More importantly, this was the first sign of primary ENHL. Thus, BEMC should rise the possibility of early malignancy which will allow early diagnosis and intervention.</div></div>","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"140 3","pages":"Page e80"},"PeriodicalIF":1.9000,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2212440325009101","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"DENTISTRY, ORAL SURGERY & MEDICINE","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

Bilateral enlargement of the mandibular canals (BEMC) is extremely rare and the differential diagnosis includes vascular malformation, benign neural tumors, or localized hypertrophic neuropathy. Extranodal non-Hodgkin’s lymphoma (ENHL) involving the mandibular canals is exceptionally rare with only five cases reported. Herein, we report an interesting case of ENHL presented as BEMCs.

Materials and Methods

A 43-year-old Saudi woman came to our oral surgery clinic complaining of heaviness in her mandible for 9 months. The panoramic radiograph revealed a bilateral diffuse uniform thickening of the mandibular canal. MRI showed isolated bilateral thickening and enhancement of mandibular branches of the trigeminal nerves with no involvement to the adjacent structures.

Results

An incisional biopsy was performed and microscopic examination showed a diffuse lymphocytic infiltration admixed with few plasma cells in a background of fibrosis. Neoplastic cells were positive for CD20 and PAX5 with Kappa chain restriction. Cyclin D1, IgG4, BCL6, and CD10 were negative. IgH rearrangement was positive for the clonal-B-cell receptor (IGH) gene.

Conclusions

We present an extremely unusual case of ENHL expanding the radiographic differential diagnosis of BEMC. More importantly, this was the first sign of primary ENHL. Thus, BEMC should rise the possibility of early malignancy which will allow early diagnosis and intervention.

查看原文本刊更多论文

结外非霍奇金淋巴瘤表现为双侧下颌骨管肿大1例

双侧下颌管肿大（BEMC）极为罕见，其鉴别诊断包括血管畸形、良性神经肿瘤或局部肥厚性神经病。结外非霍奇金淋巴瘤（ENHL）累及下颌管是非常罕见的，只有5例报告。在此，我们报告了一个有趣的以bemc形式呈现的ENHL病例。材料与方法一名43岁的沙特女性以下颌骨重9个月来我口腔外科就诊。全景x线片显示双侧下颌管弥漫性均匀增厚。MRI显示孤立的双侧三叉神经下颌骨分支增厚和增强，未累及邻近结构。结果行切口活检，镜下可见弥漫性淋巴细胞浸润，伴少量浆细胞，呈纤维化背景。肿瘤细胞CD20和PAX5阳性，Kappa链限制。Cyclin D1、IgG4、BCL6、CD10均为阴性。克隆b细胞受体（clone - b cell receptor, IgH）基因重排阳性。结论我们报告了一例极为罕见的ENHL病例，扩大了BEMC的影像学鉴别诊断。更重要的是，这是原发性ENHL的第一个迹象。因此，BEMC应提高早期恶性肿瘤的可能性，以便早期诊断和干预。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Oral Surgery Oral Medicine Oral Pathology Oral Radiology DENTISTRY, ORAL SURGERY & MEDICINE-

CiteScore

3.80

自引率

6.90%

发文量

1217

审稿时长

2-4 weeks

期刊介绍： Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology is required reading for anyone in the fields of oral surgery, oral medicine, oral pathology, oral radiology or advanced general practice dentistry. It is the only major dental journal that provides a practical and complete overview of the medical and surgical techniques of dental practice in four areas. Topics covered include such current issues as dental implants, treatment of HIV-infected patients, and evaluation and treatment of TMJ disorders. The official publication for nine societies, the Journal is recommended for initial purchase in the Brandon Hill study, Selected List of Books and Journals for the Small Medical Library.