Oral lymphoma: a case series

This case series highlights the important role general dental practitioners play in the general screening and management pathways for rare oral malignancies outside the routinely diagnosed common oral conditions, which may present as innocuous swellings, ulcers or bony lesions, without any systemic signs to raise suspicion. By far the most common oral malignancy is squamous cell carcinoma however, rarely, malignant salivary gland tumours and oral lymphoma may present in the oral cavity, and should raise clinical suspicion.¹ Lymphomas encompass a broad range of cancers derived from lymphocytes (immune cells). These can occur both within lymph nodes and also extra-nodally within soft tissue and bone, including the oral cavity. Lymphomas can be divided broadly into Hodgkin's and Non-Hodgkin's type based on cell morphology and the presence of Reed-Sternberg cells (large binucleated cells with a distinct histological appearance). Hodgkin's lymphoma develops in the lymphatics, within lymph nodes, whereas Non-Hodgkin's lymphoma (NHL) can present intra- or extra-nodally, including in the oral cavity.² Both Hodgkin's and Non-Hodgkin's lymphoma can be divided into further subtypes according to histological morphology and lineage. The majority of adult presentations of Non-Hodgkin's lymphomas are Diffuse Large B Cell Lymphoma (DLBCL),³ where the cell population is dominated by large neoplastic B cells. Five cases of extra-nodal oral NHL are described, including DLBCL, Richter's transformation of Chronic Lymphocytic Leukaemia (CLL), where DLBCL develops in patients with a history of CLL, and Follicular Lymphoma (FL). These patients presented to the Oral Medicine Department between 2012 and 2016 with a variety of oral presentations, with varying degrees of systemic involvement and dissemination. All cases were ultimately managed by the Haematology Department.