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Case Reports
. 2010 Sep;39(6):383-8.
doi: 10.1259/dmfr/16059055.

Radiographic enlargement of mandibular canal as first feature of non-Hodgkin's lymphoma

N Buric  1 , G Jovanovic, Z Radovanovic, M Buric, M Tijanic
Affiliations
Case Reports

Radiographic enlargement of mandibular canal as first feature of non-Hodgkin's lymphoma

N Buric et al. Dentomaxillofac Radiol. 2010 Sep.

Abstract

Non-Hodgkin's lymphoma has the propensity to affect non-lymphoid tissue including oral tissue. Primary non-Hodgkin's lymphoma of the mandible mistreated as chronic periodontitis with diffuse enlargement of the mandibular canal and ice-cold numbness is very rarely described in English medical literature. A 57-year-old patient presented with a painful swelling on the left side of the mandible with a clinically chronic periodontitis associated with ice-cold numbness. A panoramic radiograph showed a diffuse uniform enlargement of the mandibular canal. Histological examination showed that the lesion was a primary intraosseous non-Hodgkin's lymphoma of the mandible. Immunohistochemical examination showed a positive reaction for CD20+, Ki-67+. Seven months after chemotherapy the patient was observed for possible life-threatening propagation of the disease. In conclusion, primary (extra-nodal) non-Hodgkin's lymphoma of the mandible usually clinically presents with bone swelling, teeth mobility and neurological disturbance. Radiographic features presenting as diffuse enlargement of the mandibular canal could be considered as non-Hodgkin's lymphoma.

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Figures

Figure 1
Figure 1
Extra-oral slight swelling of the left perimandible (arrows)
Figure 2
Figure 2
Primary non-Hodgkin's lymphoma of the mandible. Panoramic radiograph showing a diffuse uniform widening of the mandibular canal (arrows)
Figure 3
Figure 3
(a) Intraoral surgical appearance of the primary mandibular non-Hodgkin's lymphoma located in the mandibular canal (arrowheads). (b) Photomicrograph showing that the primary non-Hodgkin's lymphoma was composed of diffuse large lymphocytes with polymorphous and lobulated nuclei (haematoxylin and eosin stain, original magnification ×40). (c) Photomicrograph showing large mononuclear lymphoid cells positive for CD20+ (immunohistochemical stain, original magnification ×20). (d) Photomicrograph showing high nuclei positiveness of PNHL to Ki-67
Figure 4
Figure 4
(a) Second panoramic radiograph showing a new osteolytic lesion located paramentally in the right mandible (arrows). (b) Third panoramic radiograph showing progression of the osteolytic lesion in the right mandible associated with external root resorption (small arrow). On the left side of the mandible there is radiological regression of primary (extra-nodal) non-Hodgkin's lymphoma (large arrow)
Figure 5
Figure 5
Transversal slice acquisition projection images. (a) Improvement in radiological findings on the left side of the mandible showing bounded radiolucency in the paramental region. (b) Diffuse radiolucency of the right mandible indicating spreading of primary (extra-nodal) non-Hodgkin's lymphoma
Figure 6
Figure 6
Spherical radiolucency and enlargement in the left mandibular canal region with multislice CT
See this image and copyright information in PMC

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