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ORAL LYMPHOMA
UPAMA SISHAN
2
INTRODUCTION
HISTOLOGY OF LYMPH NODES
ORIGIN OF LYMPHOID CELLS
CLASSIFICATION OF LYMPHOMA
HODGKINS LYMPHOMA
NONHODGKINS ...
3
COMPLICATONS
SUMMARY
REFERENCES
Hematopoietic
stem cell
Neutrophils
Eosinophils
Basophils
Monocytes
Platelets
Red cells
Myeloid
progenitor
Lymphoid
progen...
5
8
10
Centrocytes (small cleaved cells)
• Small cells
• Cytoplasm - scant
• Irregular or cleaved nuclear
contours
• Condensed...
ALL MMCLL Lymphomas
Hematopoietic
stem cell
Neutrophils
Eosinophils
Basophils
Monocytes
Platelets
Red cells
Myeloid
progen...
12
Definition
Malignant lymphoma is a neoplastic proliferative process of the
lymphopoietic portion of the reticuloendothe...
13
EVOLUTION OF LYMPHOMA
CLASSIFICATION
• Rappaport (considered cytologicaland
architectural features)(1966)
• Lukes and Coll...
CLASSIFICATION
Rappaport Classification (1966)
• First popularly used system
• Divided growth patterns into nodular and di...
WORKING FORMULATION FOR CLINICAL
USE (1982)
• Establish a common language of communication between
pathologists and clinic...
REAL/ WHO 2001/ WHO 2008 CLASSIFICATION OF
B – CELL LYMPHOMAS
REAL/ WHO 2001/ WHO 2008 CLASSIFICATION
OF THE T/NK CELL LYMPHOMAS
2008 WHO Classification of Hodgkin Lymphoma
19
A
B
5 UNCLASSIFIED
20
HODGKIN
LYMPHOMA
21
22
Definition (WHO)
HL is a type of malignant lymphoma in which Reed-Sternberg cells
are present in a “characteristic back...
23
A possible model of pathogenesis
germinal
centre
B cell
transforming
event(s)
loss of apoptosis
RS cell
inflammatory
respo...
Cytokines (such as IL-5, IL-10, IL-13, and
TGF-β) and chemokines (such as TARC, MDC,
IP-10, and CCL28) are secreted by Ree...
26
FORMATION OF REED STERNBERG CELLS
EBV
Infects B cells Which has undergone VDJ recombination somatic
hypermutation
Will ...
REED-STERNBERG CELL
27
Classic Reed-Sternberg cell:
+ CD15, CD30, CD25
– CD45, pan-B, S-100, keratin, EMA
RS Cell Variants
29
MUMMIFIED
CELL VARIANT
30
SYNCYTIAL VARIANT
31
NODULAR LYMPHOCYTE PREDOMINANT
32
LYMPHOCYTE RICH
33
NODULAR SCLEROSIS
Nodular sclerosis type. A low-power view shows well-defined
bands of pink, acellular collagen that subdivide the tumor int...
35
MIXED CELLULARITY
LYMPHOCYTE DEPLETED
36
37
HODGKINS LYMPHOMA IN ORAL CAVITY
Primary / relaspsed HL in oral soft tissue & jaws are rare
 oral mucosa – only 12 cas...
38
A 71 year old male presented with
a swelling in the left mandibular
buccal vestibule and buccal
mucosa, lateral to his ...
39
NON-HODGKIN’S LYMPHOMAS (nhls) represent a
heterogeneous group of malignancies that arise from the lymphoid
system which c...
PATHOGENESIS:
42
43
44
Anatomic location of thirty-one cases of NHL in the oral
region arising in soft tissues
45
Oral manifestations
Disease of oral cavity is extranodal.
• The disease can be due to Manifestation of disseminated dis...
46
Lymphomas of bone in oral cavity
• vague pain or discomfort which might be mistaken form
toothache.
• Tooth mobility an...
47
Of a total of 1,467 cases of extranodal NHL studied by Freeman and
co-workers
 417 (28percent) - head and neck region....
48
• characterized by diffuse proliferation of large neoplastic B-
lymphoid cells with nuclear size equal to or exceeding ...
49
Centroblasts ( large atypical
pleomorphic lymphocytic nucleus
with multiple nucleoli)
Swelling in the anterior hard pal...
50
SUBCLASSIFICATION OF DLBCL affecting oral cavity
51
CLINICAL, HISTOLOGICALAND IMMUNOLOGICAL DD
OF DLBCL
52
CLINICAL, HISTOLOGICALAND IMMUNOLOGICAL DD
OF DLBCL
53
Oral PBL is rare
recently described B-cell derived lymphoma
most commonly seen in patients with HIV infection.
characte...
54
Plasmablastic lymphoma
PBL has found a place in the World Health Organization
(WHO) 2000 classification as a distinct t...
55
BURKITT LYMPHOMA
• highly aggressive NHL that has the highest cell proliferation rate
among human neoplasms.
• occurs p...
56
There are three clinical variants of BL:
1. Endemic BL - children in Africa and Papua New Guinea as jaw or
orbital mass...
57
A retrospective review of patients with
Burkitt's lymphoma in the facial (1978 -
1997) .
SITES: mandible, maxilla, pala...
58
H/P: sheets of round cells
with vesicular nuclei &
indistinct cytoplasm
interspersed with
lymphocytes with
condensed nu...
59
60
MANTLE CELL LYMPHOMA
• MCL includes small-medium
sized lymphoid cells and
accounts for 6–10% of all B-cell
lymphomas.
•...
61
62
Nuclei of small cells have
distinct hyperchromatism.
Mild nuclear
pleomorphism is also
evident
Diffuse small cell
lymph...
63
Tumoral cells stained diffusely
positive with CD20
Tumoral cells showed nuclear
positivity with cyclin D1
staining
64
65
FOLLICULAR LYMPHOMA:
Follicular lymphomas accounts for one third of NHL.
• This is a low to intermediate grade lymphoma...
66
A case follicular lymphoma which
presented as a salivary gland
tumour – submandibular gland
• Destruction of salivary g...
67
Photomicrograph showing
neoplastic cells expressing strong
positivity for Bcl-2.
neoplastic cells expressing strong
pos...
EXTRANODAL MARGINAL ZONE B-CELL LYMPHOMA
• Lymphoma of MALT.
• Indolent lymphoma in mucosal sites and in extranodal tissue...
69
• Sheets of monocytoid B cells & includes lymphoepithelial
formations
IMMUNOPHENOTYPE
CD 19 +
CD 20 +
CD 10 – ( FOLLICU...
70
MYCOSIS FUNGOIDES –Cutaneous T-cell
lymphoma/SEZARY SYNDROME
• is a distinctive variant of NHL
• Characterized by a mal...
71
72
Clinical presentation
• ulcerated tumors, indurated plaques, papules, leukoplakia-like
lesions, nodules, and multiple e...
73
• consist of a dense infiltrate of atypical
pleomorphic lymphocytes.
• characteristic Pautrier's microabscesses
can be ...
74
EXTRANODAL NASAL-TYPE NATURAL KILLER (NK)/T-
CELL LYMPHOMA
Represents a rare entity
Typically originating in the nasal ...
75
NASAL EXTRANODAL NK/T-CELL LYMPHOMA
76
LYMPHOMAS OFSALIVARY GLANDS
LYMPHOMAS – LYMPH NODES
LYMPHOID TISSUES
EMBEDDED IN SG
1.7% - BRITISH SERIES OF 40 CASES O...
77
• Parotid gland 80% of cases
• Submandibular gland (16%)
• Sublingual gland and minor salivary glands (2%).
78
79
PATHOGENESIS:
• Lymphoid tissues closely asso with SG
• Especially parotid gland- 5 – 10 lymph node embedded
• Several ...
Ann Arbor Staging System
• Stage I: Single lymph node region (I) or single extralymphatic organ or
site (IE)
• Stage II: >...
Stage I Stage II Stage III Stage IV
Staging of lymphoma
A: absence of B symptoms
B: fever, night sweats, weight loss
81
DIAGNOSIS
• Blood test
• Lactate Dehydrogenase (LDH)
• Biopsy
• Bone Marrow Biopsy
• CT, and PET scans
• Immunohistochemistry
• Flow Cytometry
• Fluorescence in Situ Hybridization (FISH): to detect changes in
specific chromos...
84
Oral lymphoma often is a component of a disseminated disease process that may
involve regional nodes as well. Other tim...
85
REFERENCES:
• IOACHIMS – Lymph node pathology 4th edition
• NEVILLE – Oral and maxillofacial pathology
• SHAFERS - Oral...
86
• Vega F, Lin P, Medeiros LJ: Extranodal lymphomas of the head
and neck. Ann Diagn Pathol 9:340, 2005
• Wertheim L, Smi...
 oral lymphoma
 oral lymphoma
 oral lymphoma
 oral lymphoma
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oral lymphoma

  1. 1. ORAL LYMPHOMA UPAMA SISHAN
  2. 2. 2 INTRODUCTION HISTOLOGY OF LYMPH NODES ORIGIN OF LYMPHOID CELLS CLASSIFICATION OF LYMPHOMA HODGKINS LYMPHOMA NONHODGKINS LYPHOMA LYMPHOMA IN SALIVARY GLANDS STAGING INVESTIGATIONS
  3. 3. 3 COMPLICATONS SUMMARY REFERENCES
  4. 4. Hematopoietic stem cell Neutrophils Eosinophils Basophils Monocytes Platelets Red cells Myeloid progenitor Lymphoid progenitor T-lymphocytes Plasma cells B-lymphocytes naïve
  5. 5. 5
  6. 6. 8
  7. 7. 10 Centrocytes (small cleaved cells) • Small cells • Cytoplasm - scant • Irregular or cleaved nuclear contours • Condensed chromatin These cells are majority in follicular lymphoma Centroblasts • Large cells • Cytoplasm – moderate • Nuclei – round • Regular nuclear contour • With open nuclear chromatin Nucleoli – multiple and several (bound to the membrane) Tumors showing these cells Follicular lymphoma
  8. 8. ALL MMCLL Lymphomas Hematopoietic stem cell Neutrophils Eosinophils Basophils Monocytes Platelets Red cells Myeloid progenitor Lymphoid progenitor T-lymphocytes Plasma cells B-lymphocytes naïve
  9. 9. 12 Definition Malignant lymphoma is a neoplastic proliferative process of the lymphopoietic portion of the reticuloendothelial system that involves cells of either the lymphocytic or histiocytic series in varying degrees of differentiation and occurs in an essentially homogenous population of a single cell type. (Lukes) MALIGNANT LYMPHOMAS NON HODGKINS Lymphomas Leukemias HODGKINS
  10. 10. 13
  11. 11. EVOLUTION OF LYMPHOMA CLASSIFICATION • Rappaport (considered cytologicaland architectural features)(1966) • Lukes and Collins (immunophenotype)(1973) • Kiel Classification(Europe)(1973) • WorkingFormulation(USA) • REAL Classification(1992) • WHO classification(2001) • Update of WHO classification(2008
  12. 12. CLASSIFICATION Rappaport Classification (1966) • First popularly used system • Divided growth patterns into nodular and diffuse; • Cells types into well differentiated, poorly differentiated (cleaved follicular center cells), histiocytic (large cells) undifferentiated (round; between lymphocytes and histiocytic), and Burkitt’s. Lukes-Collins Classification (1973) • Based on proposed cell of origin; follicular center cells, cleaved or uncleaved; immunoblasts; B or T Cells Kiel Classification (1973) • Based on low and high grade, Centroblastic, Lymphoblastic, Immunoblastic • Low grade: Lymphocytic, Lymphoplasmacytoid, Centrocytic, Centroblastic
  13. 13. WORKING FORMULATION FOR CLINICAL USE (1982) • Establish a common language of communication between pathologists and clinicians rather than to represent specific disease entities. • An individual patient can progress from one histologic type to another  Low Grade: Small lymphocytic, follicular small cleaved,follicular mixed(small cleaved and large cell)  Intermediate Grade: follicular large cell, diffuse large cell, diffuse small cleaved cell, diffuse mixed (small and large cell)  High Grade: Immunoblastic, lymphoblastic, small non-cleaved.  Misc : Composite, Mycosis fungoides, Histiocytic, Extramedullary plasmacytoma, Others
  14. 14. REAL/ WHO 2001/ WHO 2008 CLASSIFICATION OF B – CELL LYMPHOMAS
  15. 15. REAL/ WHO 2001/ WHO 2008 CLASSIFICATION OF THE T/NK CELL LYMPHOMAS
  16. 16. 2008 WHO Classification of Hodgkin Lymphoma 19 A B 5 UNCLASSIFIED
  17. 17. 20
  18. 18. HODGKIN LYMPHOMA 21
  19. 19. 22 Definition (WHO) HL is a type of malignant lymphoma in which Reed-Sternberg cells are present in a “characteristic background” of reactive inflammatory cells of various types, accompanied by fibrosis of a variable degree. Histogenesis Tumors of B cell origin - germinal center or post germinal center B cells HODGKIN LYMPHOMA • It was named after Thomas Hodgkin who first described it in 1832. • Dorothy Reed & Carl Sternberg first described the malignant cells of HL called Reed Sternberg cells. • Cervical lymphadenopathy is the most common head and neck presentation for Hodgkin's lymphoma (HL). • extranodal HL typically associated with generalized disease & a consequence of local spread from adjacent lymph nodes.
  20. 20. 23
  21. 21. A possible model of pathogenesis germinal centre B cell transforming event(s) loss of apoptosis RS cell inflammatory response EBV? cytokines 24
  22. 22. Cytokines (such as IL-5, IL-10, IL-13, and TGF-β) and chemokines (such as TARC, MDC, IP-10, and CCL28) are secreted by Reed- Sternberg cells. They lead to florid accumulation of reactive cells in tissues involved by classical HL. These reactive cells produce factors that support the growth and survival of the tumor cells and further modify the reactive cell response. 25
  23. 23. 26 FORMATION OF REED STERNBERG CELLS EBV Infects B cells Which has undergone VDJ recombination somatic hypermutation Will express LMP1( protein encoded by EBV genome) upregulates NF kb Which rescues crippled germinal centre B cells that cannot express Igs from apoptosis Promote lymphocyte survival & proliferations Produce reed sternberg cells
  24. 24. REED-STERNBERG CELL 27 Classic Reed-Sternberg cell: + CD15, CD30, CD25 – CD45, pan-B, S-100, keratin, EMA
  25. 25. RS Cell Variants
  26. 26. 29 MUMMIFIED CELL VARIANT
  27. 27. 30 SYNCYTIAL VARIANT
  28. 28. 31 NODULAR LYMPHOCYTE PREDOMINANT
  29. 29. 32 LYMPHOCYTE RICH
  30. 30. 33 NODULAR SCLEROSIS
  31. 31. Nodular sclerosis type. A low-power view shows well-defined bands of pink, acellular collagen that subdivide the tumor into nodules 34
  32. 32. 35 MIXED CELLULARITY
  33. 33. LYMPHOCYTE DEPLETED 36
  34. 34. 37 HODGKINS LYMPHOMA IN ORAL CAVITY Primary / relaspsed HL in oral soft tissue & jaws are rare  oral mucosa – only 12 cases  jaw – extremely rare The primary site - Waldeyer’s ring • Nasopharynx • Tonsil • base of tongue • posterior pharyngeal wall DISSEMINATED HL more common – only 5 cases (tongue, palate, tonsil)
  35. 35. 38 A 71 year old male presented with a swelling in the left mandibular buccal vestibule and buccal mucosa, lateral to his left mandible. NODULAR SCLEROSIS
  36. 36. 39
  37. 37. NON-HODGKIN’S LYMPHOMAS (nhls) represent a heterogeneous group of malignancies that arise from the lymphoid system which can involve - both lymph nodes & lymphoid organs - extranodal organs & tissues In oral cavity: NHLs of the oral cavity are rare Account for only 2-3% of all the lymphomas reported. Oral cavity - large B cell lymphoma – 60% Of cases
  38. 38. PATHOGENESIS:
  39. 39. 42
  40. 40. 43
  41. 41. 44 Anatomic location of thirty-one cases of NHL in the oral region arising in soft tissues
  42. 42. 45 Oral manifestations Disease of oral cavity is extranodal. • The disease can be due to Manifestation of disseminated disease • Primary disease of the oral tissues and has not spread to other sites. (Sole expression of the disease or the initial manifestation of generalized disease). Oral sites 1. Oral soft tissues 2. Centrally within jaws. Presentation – oral lesions grow rapidly and then ulcerate. Some cases they can become large, fungating, necrotic, foul smelling masses. Soft tissue mass Non tender diffuse swellings. Most common buccal vestibule, posterior hard palate or gingiva. swellings have a boggy consistency. Lesion may be erythematous or purplish. May or may not be ulcerated.
  43. 43. 46 Lymphomas of bone in oral cavity • vague pain or discomfort which might be mistaken form toothache. • Tooth mobility and pain may develop. • Parasthesia in the mandible (numb chin syndrome) • Ulcerated – then bony expansion eventually perforating the cortex producing a soft tissue swelling. Systemic symptoms like fever, night sweats, weight loss and fatigue, pruritis noted.
  44. 44. 47 Of a total of 1,467 cases of extranodal NHL studied by Freeman and co-workers  417 (28percent) - head and neck region. • Tonsils, 32 % • Salivary glands 16.5 % • Oral cavity 9.5 % • Nasopharynx - 8.8 % • Thyroid - 8.6 % • Nose - 7.9 %
  45. 45. 48 • characterized by diffuse proliferation of large neoplastic B- lymphoid cells with nuclear size equal to or exceeding normal macrophage nuclei or more than twice the size of a normal lymphocyte (>20 μm). • 7th decade of life • clinically a rapidly enlarging • often symptomatic mass is typically seen Extraoral sites: mediastinum, GIT, bone marrow, CNS, breast & testes. Oral site: Waldeyer's ring, maxillary alveolus, maxillary vestibule & posterior palate. DIFFUSE LARGE B-CELL LYMPHOMA
  46. 46. 49 Centroblasts ( large atypical pleomorphic lymphocytic nucleus with multiple nucleoli) Swelling in the anterior hard palate with surface ulceration
  47. 47. 50 SUBCLASSIFICATION OF DLBCL affecting oral cavity
  48. 48. 51 CLINICAL, HISTOLOGICALAND IMMUNOLOGICAL DD OF DLBCL
  49. 49. 52 CLINICAL, HISTOLOGICALAND IMMUNOLOGICAL DD OF DLBCL
  50. 50. 53 Oral PBL is rare recently described B-cell derived lymphoma most commonly seen in patients with HIV infection. characterised by a diagnostic triad of predilection for 1. Gingivo-buccal complex mucosa, 2. Classical plasmablastic morphology with the lack of neoplastic plasma cells 3. A limited immunohistochemical panel CD20 negativity LCA (+/), CD138/VS38c diffuse positivity, light chain restriction & high Mib-1(Ki 67) index. Prognosis is usually poor regardless of the site of origin. PLASMABLASTIC LYMPHOMA
  51. 51. 54 Plasmablastic lymphoma PBL has found a place in the World Health Organization (WHO) 2000 classification as a distinct type of AIDS-related lymphoma and is accepted to be a variant of DLBCL.
  52. 52. 55 BURKITT LYMPHOMA • highly aggressive NHL that has the highest cell proliferation rate among human neoplasms. • occurs predominantly in the first decades of life • mostly in males • with significant affinity for gnathic bones – 50 – 70% cases • maxilla: mandible – 2:1 • Posterior segments of the jaw • Sometimes – 4 quadrant involvement Jaw involvement seems to be age related: • 90% - 3 yrs old pt • 25% - pts older than 15 yrs
  53. 53. 56 There are three clinical variants of BL: 1. Endemic BL - children in Africa and Papua New Guinea as jaw or orbital masses 2. Sporadic BL- no specific age or geographic predilection and occurs with abdominal or nodal involvement 3. HIV associated BL
  54. 54. 57 A retrospective review of patients with Burkitt's lymphoma in the facial (1978 - 1997) . SITES: mandible, maxilla, palate TUMOUR- facial swelling /exophytic mass / as an ulcer..
  55. 55. 58 H/P: sheets of round cells with vesicular nuclei & indistinct cytoplasm interspersed with lymphocytes with condensed nuclei. Few macrophages were seen between the tumour cells .
  56. 56. 59
  57. 57. 60 MANTLE CELL LYMPHOMA • MCL includes small-medium sized lymphoid cells and accounts for 6–10% of all B-cell lymphomas. • Common extra-nodal sites - RARE • Waldeyer's ring, gastrointestinal tract, bone marrow and peripheral blood. • INTRORAL: 9 cases • Common site: palate….floor of mouth…Base of tongue Palatal MCL is mostly seen in elderly people and may be masked with the presence of prosthesis
  58. 58. 61
  59. 59. 62 Nuclei of small cells have distinct hyperchromatism. Mild nuclear pleomorphism is also evident Diffuse small cell lymphocytic infiltration is the predominant component on histology.
  60. 60. 63 Tumoral cells stained diffusely positive with CD20 Tumoral cells showed nuclear positivity with cyclin D1 staining
  61. 61. 64
  62. 62. 65 FOLLICULAR LYMPHOMA: Follicular lymphomas accounts for one third of NHL. • This is a low to intermediate grade lymphoma • show a follicular architecture • represents the neoplastic counterpart of germinal center B lymphocytes. Few case reports – in salivary glands • Among lymphomas originating from salivary glands, the ratio of follicular lymphoma is very low.
  63. 63. 66 A case follicular lymphoma which presented as a salivary gland tumour – submandibular gland • Destruction of salivary gland architecture. • No acinar cell/ducts were seen. • The entire mass was infiltrated by proliferation of lymphocytes which were arranged in sheets.. • neoplastic lymphocytes in a follicular pattern.
  64. 64. 67 Photomicrograph showing neoplastic cells expressing strong positivity for Bcl-2. neoplastic cells expressing strong positivity for CD20
  65. 65. EXTRANODAL MARGINAL ZONE B-CELL LYMPHOMA • Lymphoma of MALT. • Indolent lymphoma in mucosal sites and in extranodal tissues including the gastrointestinal tract, salivary glands, lung, thyroid gland, and skin. • Any age-group or gender can be affected • Associated with Sjogren's syndrome • female predominance. • Populated by lymphocytes such as T cells and B cells, as well as plasma cells and macrophages
  66. 66. 69 • Sheets of monocytoid B cells & includes lymphoepithelial formations IMMUNOPHENOTYPE CD 19 + CD 20 + CD 10 – ( FOLLICULAR L) CD 5 -- (MANTLE CELL L)
  67. 67. 70 MYCOSIS FUNGOIDES –Cutaneous T-cell lymphoma/SEZARY SYNDROME • is a distinctive variant of NHL • Characterized by a malignant proliferation of helper (CD4+) T-lymphocytes & less commonly suppressor (CDS+) T- lymphocytes. • with a predilection to involve the skin. • The mouth is an rare site • only 31 cases of oral CTCL have been reported in English literature • Oral lesions almost always develop after cutaneous lesions
  68. 68. 71
  69. 69. 72 Clinical presentation • ulcerated tumors, indurated plaques, papules, leukoplakia-like lesions, nodules, and multiple erosions • Dysphagia commonly associated Oral lesions appear to be a late manifestation of mycosis fungoides that arise on skin
  70. 70. 73 • consist of a dense infiltrate of atypical pleomorphic lymphocytes. • characteristic Pautrier's microabscesses can be found. • These features are similar to those seen in cutaneous lesions
  71. 71. 74 EXTRANODAL NASAL-TYPE NATURAL KILLER (NK)/T- CELL LYMPHOMA Represents a rare entity Typically originating in the nasal cavity palate or midfacial region. Signs and symptoms • non-specific rhinitis and/or sinusitis • nasal obstruction • epistaxis, facial swelling • development of deep necrotic ulceration in the midline of the palate, causing an oronasal defect. • Differential diagnosis: fungal infections, Wegener’s granulomatosis, tertiary syphilis, other non-Hodgkin’s lymphomas & malignant epithelial midline tumors.
  72. 72. 75 NASAL EXTRANODAL NK/T-CELL LYMPHOMA
  73. 73. 76 LYMPHOMAS OFSALIVARY GLANDS LYMPHOMAS – LYMPH NODES LYMPHOID TISSUES EMBEDDED IN SG 1.7% - BRITISH SERIES OF 40 CASES OF SG TUMOURS 2.45% – AMERICAN SERIES OF 366 CASES • LOW GRADE LYMPHOMA - Predominant in all studies • HIV/AIDS Associated – high grade large cell lymphoma
  74. 74. 77 • Parotid gland 80% of cases • Submandibular gland (16%) • Sublingual gland and minor salivary glands (2%).
  75. 75. 78
  76. 76. 79 PATHOGENESIS: • Lymphoid tissues closely asso with SG • Especially parotid gland- 5 – 10 lymph node embedded • Several lymph node – submaxillary gland • SG acini & ducts present in medulla of upper cervical lymph nodes • These nodes – target for viral/bacterial infections anti- immune diseases Lymphomas – site for long standing benign lesions Sjogrens lymphadenopathies HIV lymphadenitis COMMON – 1. Marginal zone Bcell L 2. DLBCL
  77. 77. Ann Arbor Staging System • Stage I: Single lymph node region (I) or single extralymphatic organ or site (IE) • Stage II: > 2 lymph node regions on same side of diaphragm (II) or with limited, contiguous extra lymphatic tissue involvement (IIE) • Stage III: both sides of diaphragm involved, may include spleen (IIIS) or local tissue involvement (IIIE) • Stage IV: multiple/disseminated foci involved with > 1 extralymphatic organs (i.e. bone marrow) (A) or (B) designates absence/presence of “B” symptoms *(E) Localized, solitary involvement of extralymphatic tissue, excluding liver and bone marrow 80
  78. 78. Stage I Stage II Stage III Stage IV Staging of lymphoma A: absence of B symptoms B: fever, night sweats, weight loss 81
  79. 79. DIAGNOSIS • Blood test • Lactate Dehydrogenase (LDH) • Biopsy • Bone Marrow Biopsy • CT, and PET scans
  80. 80. • Immunohistochemistry • Flow Cytometry • Fluorescence in Situ Hybridization (FISH): to detect changes in specific chromosomes. • Polymerase Chain Reaction (PCR): to detect specific DNA sequences that occur in some cancers • DNA Microarray
  81. 81. 84 Oral lymphoma often is a component of a disseminated disease process that may involve regional nodes as well. Other times, it may represent a primary extranodal disease confined to oral cavity or jaws, which is very rare
  82. 82. 85 REFERENCES: • IOACHIMS – Lymph node pathology 4th edition • NEVILLE – Oral and maxillofacial pathology • SHAFERS - Oral and maillofacial pathology • ROBBINS – Basic pathology 8th edition • Eisenbud L,Oral presentations in non-Hodgkin's lymphoma: a review of thirty-one cases. Part II. Fourteen cases arising in bone. Oral Surg Oral Med Oral Pathol. 1984;57:272–80. • Kolokotronis , et al. Localized B-cell non-Hodgkin's lymphoma of oral cavity and maxillofacial region: A clinical study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;99:303–10.
  83. 83. 86 • Vega F, Lin P, Medeiros LJ: Extranodal lymphomas of the head and neck. Ann Diagn Pathol 9:340, 2005 • Wertheim L, Smith GS. Mycosis fungoides. Arch Dermatol Syphilol 1948; 57: 625 ± 635. • Tolman MM. Mycosis fungoides in a 56-year-old woman. Arch Dermatol Shypilol 1949; 60: 929 ± 930. • Cho G, Suh IS, Tak KS, Park YK, Ko EY, Sung HM, et al. Primary Parotid Non-Hodgkin’s lymphoma: Case report. J Korean Cleft Palate-Craniofac Assoc 2010;11:99-102. • Armstrong R, Bradrick J, Liu Y.Spontaneous regression of an HIV-associated lymphoblastic lymphoma in the oral cavity: a case report. J Oral Maxillofac Surg 2007: 65: 1361–1364 • Borrero JJ, Pujol E, Perez S, MerinoD, Montano A, Rodriguez FJ. Plasmablastic lymphoma of the oral cavity and jaws. AIDS 2002: 16: 1979–1980.

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