Early diagnosis of an isolated primary peripheral T-cell lymphoma masquerading as massive gingival enlargement in a pediatric patient

Abstract

Lymphomas are malignant neoplasm of the lymphocyte cell lines, classified as either Hodgkin's or non-Hodgkin's lymphoma (NHL). NHL comprises a heterogeneous group of lymphoid neoplasm arising from B-cell, T-cell or natural killer cell with a spectrum of behavior ranging from relatively indolent to highly aggressive and potentially fatal. Peripheral T-cell lymphoma, a variant of NHL, is a disease characterized by the presence of diffuse lymphadenopathy, extranodal involvement, classical B symptoms such as fever (>100.4°F) for 3 consecutive days, weight loss exceeding 10% of body weight in 6 months and drenching night sweats with a tendency for recurrence. Among NHLs, extranodal presentations are relatively common. Extranodal presentation particularly in the oral cavity is very rare and may misinterpret the diagnosis. Lesions of this type should be cautiously dealt especially in pediatric patients and young adolescents. The present case report is about an atypical presentation of disease process in a 15-year-old male patient, which was diagnosed early with the help of a combination of histopathology and immunohistochemistry techniques.

Keywords: CD20; CD3; T-cell; gingiva; lymphoma; peripheral.

Figure 1

(a) Extraoral photograph showing incompetent lips, (b) marked diffuse gingival enlargement with respect to maxillary arch, (c) marked diffuse gingival enlargement with respect to mandibular arch, (d) erythematous swelling noticed in right buccal vestibule of maxilla and bulbous interdental papillae

Figure 2

(a) Parakeratinized stratified squamous epithelium with underlying diffuse infiltrate of lymphoid cells (×100), (b) areas of necrosis inside the tumor mass, (c) monotonously arranged round lymphoid cells with hyperchromatic nuclei (×400), (d) invasion of tumor cells around the blood vessels (×400)

Figure 3

(a) IHC staining with CD3 marker showing positivity for malignant cells (×100), (b) IHC staining with CD20 marker showing negativity for malignant cells (×100), (c) CD3-positive tumor cells (×400), (d) tumor cells infiltrating around the blood vessel (×400)