Head and Neck Pathology

, Volume 13, Issue 4, pp 711–717 | Cite as

T-Cell/Histiocyte-Rich Large B-Cell Lymphoma: Report of the First Case in the Mandible

  • Ricardo Natã Fonseca Silva
  • Elismauro Francisco Mendonça
  • Aline Carvalho Batista
  • Rita de Cássia Gonçalves Alencar
  • Ricardo Alves Mesquita
  • Nadia Lago CostaEmail author
Case Report


T-cell/histiocyte-rich large B-cell lymphoma (THRBCL) is an uncommon subtype of non-Hodgkin’s lymphoma. It is a predominant nodal neoplasm; however, extranodal sites, such as the spleen, liver and bone marrow, can be involved at diagnosis. However, only one case of primary THRLBCL in the jaws have been reported. We herein describe a 29-year-old female patient who presented with a swelling of the right mandible that had grown rapidly over the previous 2 months. Periapical and panoramic radiographs showed a multilocular osteolytic lesion located in the mandibular periapical region of the canine and premolar teeth and molar region. Preoperative examination and incisional biopsy were performed. Immunohistochemistry was applied to confirm the diagnosis of THRBCL in the jaw. The treatment consisted of CHOP therapy and radiotherapy. After complete tumor remission following initial treatment, additional sites of the disease appeared in the lung, abdomen and long bones. The patient died within 2 months. THRLBCL is an uncommon and aggressive malignant neoplasm that can involve the jaws, mimicking a periapical disease.


Jaw Lymphoma Non-hodgkin Lymphoma Large B-cell Diffuse Periapical diseases 



The first author declares no funding grants were received or otherwise associated with the production of this paper.

Compliance with Ethical Standards

Conflict of interest

All authors named in this case report declare that they have no conflict of interest.

Research Involving Human and Animal Participants

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Epstein JB, Epstein JD, Le ND, Gorsky M. Characteristics of oral and paraoral malignant lymphoma: a population-based review of 361 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;92:519–25.CrossRefGoogle Scholar
  2. 2.
    Kemp S, Gallagher G, Kabani S, Noonan V, O’Hara C. Oral non-Hodgkin’s lymphoma: review of the literature and World Health Organization classification with reference to 40 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105:194–201.CrossRefGoogle Scholar
  3. 3.
    Ferry JA, Li XO. Haematolymphoid tumours. In: El-Naggar AK, Chan J, Takata T, Grandis J, Blootweg P, editors. World health classification of head and neck tumours. 4th ed. Lyon: IARC Press; 2017. pp. 128–9.Google Scholar
  4. 4.
    Abramson JS. T-cell/histiocyte-rich B-cell lymphoma: biology, diagnosis, and management. Oncologist 2006;11:384–92.CrossRefGoogle Scholar
  5. 5.
    Pittaluga S, Jaffe ES. T-cell/histiocyte-rich large B-cell lymphoma. Haematology 2010;95:352–6.CrossRefGoogle Scholar
  6. 6.
    Fraga M, Sánchez-Verde L, Forteza J, García-Rivero A, Piris MA. T-cell/histiocyte-rich large B-cell lymphoma is a disseminated aggressive neoplasm: differential diagnosis from Hodgkin’s lymphoma. Histopathology 2002;41:216–29.CrossRefGoogle Scholar
  7. 7.
    Bouabdallah R, Mounier N, Guettier C, Molina T, Ribrag V, Thieblemont C, et al. T-cell/histiocyte-rich large B-cell lymphomas and classical diffuse large B-cell lymphomas have similar outcome after chemotherapy: a matched-control analysis. J Clin Oncol. 2003;21:1271–7.CrossRefGoogle Scholar
  8. 8.
    Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H et al, editors. WHO classification of tumours of haematopoietic and lymphoid tissues. 4th ed. Lyon: IARC Press; 2017.Google Scholar
  9. 9.
    El Weshi A, Akhtar S, Mourad WA, Ajarim D, Abdelsalm M, Khafaga Y, et al. T-cell/histiocyte-rich B-cell lymphoma: clinical presentation, management and prognostic factors: report on 61 patients and review of literature. Leuk Lymphoma. 2007;48:1764–73.CrossRefGoogle Scholar
  10. 10.
    Furze AD, Defatta R, Ducic Y. Pathology case quiz 2. Diffuse large B-cell lymphoma, T-cell/histiocyte-rich morphological variant, of the hard palate. Arch Otolaryngol Head Neck Surg. 2010;136:207–8.CrossRefGoogle Scholar
  11. 11.
    Longo F, De Maria G, Esposito P, Califano L. Primary non-Hodgkin’ s lymphoma of the mandible. Report of a case. Int J Oral Maxillofac Surg. 2004;33:801–3.CrossRefGoogle Scholar
  12. 12.
    Triantafillidou K, Dimitrakopoulos J, Iordanidis F, Gkagkalis A. Extranodal non-hodgkin lymphomas of the oral cavity and maxillofacial region: a clinical study of 58 cases and review of the literature. J Oral Maxillofac Surg. 2012;70:2776–85.CrossRefGoogle Scholar
  13. 13.
    Pereira DL, Fernandes DT, Santos-Silva AR, Vargas PA, Almeida OP, Lopes MA. Intraosseous non-Hodgkin lymphoma mimicking a periapical lesion. J Endod. 2015;41:1738–42.Google Scholar
  14. 14.
    Djavanmardi L, Oprean N, Alantar A, Bousetta K, Princ G. Malignant non-Hodgkin’ s lymphoma (NHL) of the jaws: a review of 16 cases. J Craniomaxillofac Surg. 2008;36:410–4.CrossRefGoogle Scholar
  15. 15.
    Pazoki A, Jansisyanont P, Ord RA. Primary non-Hodgkin’s lymphoma of the jaws: report of 4 cases and review of the literature. J Oral Maxillofac Surg. 2003;61:112–7.CrossRefGoogle Scholar
  16. 16.
    Mendonça EF, Sousa TO, Estrela C. Non-Hodgkin lymphoma in the periapical region of a mandible canine. J Endod. 2013;39:839–42.CrossRefGoogle Scholar
  17. 17.
    Saund D, Kotecha S, Rout J, Dietrich T. Non-resolving periapical inflammation: a malignant deception. Int Endod J. 2010;43:84–90.CrossRefGoogle Scholar
  18. 18.
    Carbone M, Della Ferrera F, Carbone L, Gatti G, Carrozzo M. Numb chin syndrome as first symptom of diffuse large B-cell lymphoma. Case Rep Dent. 2014;41:3162–5.Google Scholar
  19. 19.
    Venizelos ID, Tatsiou ZA, Mandala E. Primary cutaneous T-cell-rich B-cell lymphoma: a case report and literature review. Acta Dermat. 2008;17:177–81.Google Scholar
  20. 20.
    Cornillie J, Tousseyn T, Verhoef G. T-cell/histiocyte-rich large B-cell lymphoma: review on pathologic diagnosis, current therapeutic options and new targets for therapy. Belg J Hematol. 2012;3:128–33.Google Scholar
  21. 21.
    Vezzoli P, Fiorani R, Girgenti V, Fanoni D, Tavecchio S, Balice Y, et al. Cutaneos T-cell/histiocyte-rich B-cell lymphoma: a case report and review of the literature. Dermatology 2011;222:225–30.CrossRefGoogle Scholar
  22. 22.
    Ichikawa S, Watanabe Y, Saito K, Kimura J, Ichinohasama R, Harigae H. T-cell/histiocyte-rich large B-cell lymphoma of the thyroid. Exp Hematol Oncol. 2013;2:1–3.CrossRefGoogle Scholar
  23. 23.
    Advani P, Starr J, Swaika A, Jiang L, Qiu Y, Li Z, et al. T-cell/histiocyte-rich large B-cell lymphoma presenting as a primary central nervous system lymphoma. Rare Tumors. 2015;7:161–3.CrossRefGoogle Scholar
  24. 24.
    Barut F, Kandemir NO, Gun BD, Ozdamar SO. T-cell/histiocyte-rich large B-cell lymphoma of stomach. J Park Med Assoc. 2016;66:905–7.Google Scholar
  25. 25.
    Xu J, Wu X, Reddy V. T-cell/histiocyte-rich large B-cell lymphoma of the thymus: a diagnostic pitfall. Case Rep Hematol. 2016;2016:1–7.CrossRefGoogle Scholar
  26. 26.
    Ibrahim U, Garcia G, Saqib A, Hussein S, Dai Q. T cell histiocyte rich large B cell lymphoma presenting as hemophagocytic lymphohistiocytosis: an uncommon presentation of a rare disease. Case Rep Oncol Med. 2017;2017:1–5.CrossRefGoogle Scholar
  27. 27.
    Zheng SM, Zou DJ, Chen YH, Jiang R, Wang YX, Zhang Y, et al. Pancreatic T/histiocyte-rich large B-cell lymphoma: a case report and review of literature. World J Gastroenterol. 2017;23:4467–72.CrossRefGoogle Scholar
  28. 28.
    Rodriguez J, Pugh WC, Cabanillas F. T-cell-richB-cell lymphoma. Blood 1993;82:1586–9.CrossRefGoogle Scholar
  29. 29.
    Eisenbud L, Sciubba J, Mir R, Sachs SA. 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.CrossRefGoogle Scholar
  30. 30.
    Gusenbauer AW, Katsikeris NF, Brown A. Primary lymphoma of the mandible: report of a case. J Oral Maxillofac Surg. 1990;48:409–15.CrossRefGoogle Scholar
  31. 31.
    Wright JM, Radman WP. Intrabony lymphoma simulating periradicular inflammatory disease. J Am Dent Assoc. 1995;126:101–5.CrossRefGoogle Scholar
  32. 32.
    Parrington SJ, Punnia-Moorthy A. Primary non-Hodgkin’s lymphoma of the mandible presenting following tooth extraction. Br Dent J. 1999;187:468–70.CrossRefGoogle Scholar
  33. 33.
    Kini R, Saha A, Naik V. Diffuse large B-cell lymphoma of mandible: a case report. Med Oral Patol Oral Cir Bucal. 2009;14:e421–4.Google Scholar
  34. 34.
    Agrawal MG, Agrawal SM, Kambalimath DH. Non-hodgkins lymphoma of maxilla: a rare entity. Natl J Maxillofac Surg. 2011;2:210–3.CrossRefGoogle Scholar
  35. 35.
    Fischer DJ, Klasser GD, Kaufmann R. Intraoral swelling and periapical radiolucency. J Am Dent Assoc. 2012;143:985–8.CrossRefGoogle Scholar
  36. 36.
    Hopp RN, Marchi MT, Kellermann MG, Rizo VH, Lopes MA, Jorge J. Lymphoma mimicking a dental periapical lesion. Leuk Lymphoma. 2012;53:1008–10.CrossRefGoogle Scholar
  37. 37.
    Jessri M, AbdulMajeed AA, Matias MA, Farah CS. A case of primary diffuse large B-cell non-Hodgkin’s lymphoma misdiagnosed as chronic periapical periodontitis. Aust Dent J. 2013;58:250–5.CrossRefGoogle Scholar
  38. 38.
    Wong GB, Spadafora S, Barbon N, Caputo M. Primary extranodal B-cell non-Hodgkin lymphoma mimicking an endodontic lesion: report of 2 cases. J Can Dent Assoc. 2013;79:d93.PubMedGoogle Scholar
  39. 39.
    Bugshan A, Kassolis J, Basile J. Primary diffuse large B-cell lymphoma of the mandible: case report and review of the literature. Case Rep Oncol. 2015;8:451–5.CrossRefGoogle Scholar
  40. 40.
    Zou H, Yang H, Zou Y, Lei L, Song L. Primary diffuse large B-cell lymphoma in the maxilla: a case report. Medicine 2018;97:e10707.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Ricardo Natã Fonseca Silva
    • 1
  • Elismauro Francisco Mendonça
    • 1
    • 2
  • Aline Carvalho Batista
    • 1
  • Rita de Cássia Gonçalves Alencar
    • 3
  • Ricardo Alves Mesquita
    • 4
  • Nadia Lago Costa
    • 1
    Email author
  1. 1.Department of Stomathology (Oral Pathology), School of DentistryFederal University of GoiasGoiâniaBrazil
  2. 2.Division of Head and Neck, Araújo Jorge HospitalAssociation of Cancer Combat of GoiásGoiâniaBrazil
  3. 3.Laboratory of Pathology, Araújo Jorge HospitalAssociation of Cancer Combat of GoiásGoiâniaBrazil
  4. 4.Department of Oral Surgery and Pathology, School of DentistryFederal University of Minas GeraisBelo HorizonteBrazil

Personalised recommendations