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Primary extranodal non-hodgkin lymphoma in the infra-orbital region – a diagnostic challenge

From Volume 43, Issue 9, November 2016 | Pages 844-848

Authors

Naren Thanabalan

BDS, BSc, MJDF, GDP

Specialty Dentist in Oral Surgery, Oral Surgery Department, Floor 23, Guy's Dental Hospital, London Bridge, London (naren.thanabalan3@gmail.com)

Articles by Naren Thanabalan

Vinod Patel

BDS (Hons), PhD

Consultant (Oral Surgery), Oral Surgery Department, Guy's and St Thomas' NHS Foundation Trust, London

Articles by Vinod Patel

Email Vinod Patel

Chris Sproat

BDS(Lond), MBBS(Hons), BSc(Hons), FDS RCS

Consultant (Oral Surgery), Oral Surgery Department, Floor 23, Guy's Dental Hospital, London Bridge, London, SE1 9RT, UK

Articles by Chris Sproat

Mark McGurk

MD, FRCS, DLO, FDS, RCS

Consultant, Department of Oral and Maxillofacial Surgery, Guy's, King's and St Thomas' Dental Institute, SE1 9RT, UK

Articles by Mark McGurk

Abstract

Lymphomas within the head and neck region (HNR) are relatively uncommon; however, they can mimic common odontogenic conditions leading to diagnostic delays and subsequently the implementation of treatment. We report a case of a chronic infra-orbital swelling which, following excision, was diagnosed as an extranodal low grade Non-Hodgkin lymphoma. This paper explains the mode of presentation of extranodal lymphomas in the HNR, so that dental practitioners may consider it as a potential diagnosis when presented with a lump in the HNR.

CPD/Clinical Relevance: Extranodal lymphomas presenting within the head and neck region can have a multitude of clinical presentations, which may often resemble odontogenic conditions. This can cause confusion, resulting in diagnostic delays and treatment. This case highlights the importance of being aware of the features of extranodal lymphoma in the head and neck region, and the diagnostic challenges that may be encountered.

Article

There is a wide range of conditions that can present as a lump within the head and neck region (HNR), posing diagnostic challenges.1 Unusual signs and symptoms often result in a delay in diagnosis and treatment. The main challenge for the clinician is to distinguish sinister pathology from the benign by early recognition of the cardinal features of serious disease.

Lymphomas in the HNR are difficult to diagnose as they have varied patterns of presentation and are relatively uncommon. However, they should always be considered within the differential diagnosis of a lump in the HNR, as lymphoma is the sixth most common cancer in the UK, with 12,180 new cases diagnosed in 2010; a total of 4646 people having died from the disease in 2011.2

We describe a case of a primary extranodal Non-Hodgkin lymphoma (NHL) presenting as a localized infra-orbital swelling, including the investigations leading to diagnosis and treatment.

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