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Rare case report of an aggressive follicular lymphoid hyperplasia in maxilla

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Follicular lymphoid hyperplasia is a very rare though benign reactive process of an unknown pathogenesis that may resemble a follicular lymphoma, clinically and histologically. Oral reactive follicular hyperplasia (RFH) has been described on the hard or soft palate and at the base of the tongue. We describe here the first case of RFH presenting as an aggressive tumor on the right posterior side of the maxilla in a 24-year-old male patient. The lesion had a clinical evolution of 18 months and was noticed after the surgical extraction of the right third molar, although we cannot assume a cause-effect relation with that surgical event whatsoever. His medical history was unremarkable. Following an incisional biopsy, histological examination revealed lymphoid follicles comprised by germinal centers surrounded by well-defined mantle zones. The germinal centers were positive for Bcl-6, CD10, CD20, CD21, CD23, CD79a, and Ki-67, while negative for Bcl-2, CD2, CD3, CD5, and CD138. The mantle and interfollicular zones were positive for Bcl-2, CD2, CD3, CD5, CD20, and CD138. Both areas were diffusively positive for kappa and lambda, showing polyclonality. The patient underwent a vigorous curettage of the lesion with no reoccurrences at 36 months of follow-up. This case report demonstrates that morphologic and immunohistochemical analyses are crucial to differentiate RFH from follicular lymphoma, leading to proper management.

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  1. Jham BC, Binmadi NO, Scheper MA, Zhao XF, Koterwas GE, Kashyap A et al (2009) Follicular lymphoid hyperplasia of the palate: case report and literature review. J Craniomaxillofac Surg 37:79–82.

    Article  PubMed  Google Scholar 

  2. Wright JM, Dunsworth AR (1983) Follicular lymphoid hyperplasia of the hard palate: a benign lymphoproliferative process. Oral Surg Oral Med Oral Pathol 55:162–168

    Article  CAS  PubMed  Google Scholar 

  3. Anjomshoaa I, Bulford LA, Dym H, Woo SB (2013) Florid follicular lymphoid hyperplasia of the hard palatal mucosa managed with intralesional steroids: a case report and review of the literature. J Oral Maxillofac Surg 71:1202–1208.

    Article  PubMed  Google Scholar 

  4. Kolokotronis A, Dimitrakopoulos I, Asimaki A (2003) Follicular lymphoid hyperplasia of the palate: report of a case and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 96:172–175.

    Article  PubMed  Google Scholar 

  5. Mopsik ER, Adrian JC, Klein LE (1992) Follicular lymphoid hyperplasia of the hard palate: report of a case. J Oral Maxillofac Surg 50:538–540

    Article  CAS  PubMed  Google Scholar 

  6. Menasce LP, Shanks JH, Banerjee SS, Harris M (2001) Follicular lymphoid hyperplasia of the hard palate and oral mucosa: report of three cases and a review of the literature. Histopathology 39:353–358

    Article  CAS  PubMed  Google Scholar 

  7. Barnes L, Eveson JW, Reichart P, Sidransky D (2005) Pathology and genetics head and neck tumours. IARC Press, Lyon

    Google Scholar 

  8. Philipone E, Bhagat G, Alobeid B (2015) Oral cavity lymphoid neoplasms. A fifteen-year single institution review. N Y State Dent J 81:44–47

    PubMed  Google Scholar 

  9. Kato H, Kanematsu M, Watanabe H, Kawaguchi S, Mizuta K, Aoki M (2015) Differentiation of extranodal non-Hodgkins lymphoma from squamous cell carcinoma of the maxillary sinus: a multimodality imaging approach. Spring 4:228.

    Article  Google Scholar 

  10. Good DJ, Gascoyne RD (2009) Atypical lymphoid hyperplasia mimicking lymphoma. Hematol Oncol Clin North Am 23:729–745.

    Article  PubMed  Google Scholar 

  11. Davila MA, Thompson SH (1988) Reactive lymphoid hyperplasia of the hard palate. J Oral Maxillofac Surg 46:1103–1105

    Article  CAS  PubMed  Google Scholar 

  12. Weiss LM, Loera S, Bacchi CE (2010) Immunoglobulin light chain immunohistochemistry revisited, with emphasis on reactive follicular hyperplasia versus follicular lymphoma. Appl Immunohistochem Mol Morphol 18:199–205.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Zheng Y, Zhou X, Xie J, Zhu H, Zhang S, Zhang Y et al (2014) IgM expression in paraffin sections distinguishes follicular lymphoma from reactive follicular hyperplasia. Int J Clin Exp Pathol 7:3264–3271

    PubMed  PubMed Central  Google Scholar 

  14. Nathwani BN, Winberg CD, Diamond LW, Bearman RM, Kim H (1981) Morphologic criteria for the differentiation of follicular lymphoma from florid reactive follicular hyperplasia: a study of 80 cases. Cancer 48:1794–1806

    Article  CAS  PubMed  Google Scholar 

  15. Weiss LM, O’Malley D (2013) Benign lymphadenopathies. Mod Pathol 26(Suppl 1):S88–S96.

    Article  CAS  PubMed  Google Scholar 

  16. qsujimoto Y, Cossman J, Jaffe E, Croce CM (1985) Involvement of the bcl-2 gene in human follicular lymphoma. Science 228:1440–1443

  17. Zutter M, Hockenbery D, Silverman GA, Korsmeyer SJ (1991) Immunolocalization of the Bcl-2 protein within hematopoietic neoplasms. Blood 78:1062–1068

    CAS  PubMed  Google Scholar 

  18. Gelb AB, Rouse RV, Dorfman RF, Warnke RA (1994) Detection of immunophenotypic abnormalities in paraffin-embedded B-lineage non-Hodgkin’s lymphomas. Am J Clin Pathol 102:825–834

    Article  CAS  PubMed  Google Scholar 

  19. Lai R, Arber DA, Chang KL, Wilson CS, Weiss LM (1998) Frequency of bcl-2 expression in non-Hodgkin’s lymphoma: a study of 778 cases with comparison of marginal zone lymphoma and monocytoid B-cell hyperplasia. Mod Pathol 11:864–869

    CAS  PubMed  Google Scholar 

  20. Utz GL, Swerdlow SH (1993) Distinction of follicular hyperplasia from follicular lymphoma in B5-fixed tissues: comparison of MT2 and bcl-2 antibodies. Hum Pathol 24:1155–1158

    Article  CAS  PubMed  Google Scholar 

  21. Napier SS, Newlands C (1990) Benign lymphoid hyperplasia of the palate: report of two cases and immunohistochemical profile. J Oral Pathol Med 19:221–225

    Article  CAS  PubMed  Google Scholar 

  22. Duarte IX, Domeny-Duarte P, Wludarski SC, Natkunam Y, Bacchi CE (2013) Follicular lymphoma in young adults: a clinicopathological and molecular study of 200 patients. Mod Pathol 26:1183–1196.

    Article  PubMed  Google Scholar 

  23. Gradowski JF, Jaffe ES, Warnke RA, Pittaluga S, Surti U, Gole LA et al (2010) Follicular lymphomas with plasmacytic differentiation include two subtypes. Mod Pathol 23:71–79.

    Article  PubMed  Google Scholar 

  24. Santos MR, Servato JP, Cardoso SV, de Faria PR, Eisenberg AL, Dias FL et al (2014) Squamous cell carcinoma at maxillary sinus: clinicopathologic data in a single Brazilian institution with review of literature. Int J Clin Exp Pathol 7:8823–8832

    PubMed  PubMed Central  Google Scholar 

  25. SY S, Bell D, Hanna EY (2014) Esthesioneuroblastoma, neuroendocrine carcinoma, and sinonasal undifferentiated carcinoma: differentiation in diagnosis and treatment. Int Arch Otorhinolaryngol 18:S149–S156.

    Article  Google Scholar 

  26. Kim BS, Vongtama R, Juillard G (2004) Sinonasal undifferentiated carcinoma: case series and literature review. Am J Otolaryngol 25:162–166

    Article  PubMed  Google Scholar 

  27. Ejaz A, Wenig BM (2005) Sinonasal undifferentiated carcinoma: clinical and pathologic features and a discussion on classification, cellular differentiation, and differential diagnosis. Adv Anat Pathol 12:134–143

    Article  PubMed  Google Scholar 

  28. Wolfish EB, Nelson BL, Thompson LD (2012) Sinonasal tract mucoepidermoid carcinoma: a clinicopathologic and immunophenotypic study of 19 cases combined with a comprehensive review of the literature. Head Neck Pathol 6:191–207.

    Article  PubMed  Google Scholar 

  29. Guzzo M, Locati LD, Prott FJ, Gatta G, McGurk M, Licitra L (2010) Major and minor salivary gland tumors. Crit Rev Oncol Hematol 74:134–148.

    Article  PubMed  Google Scholar 

  30. Casulo C, Byrtek M, Dawson KL, Zhou X, Farber CM, Flowers CR et al (2015) Early relapse of follicular lymphoma after rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone defines patients at high risk for death: an analysis from the national LymphoCare study. J Clin Oncol 33:2516–2522.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Correspondence to João Adolfo Costa Hanemann.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Written informed consent was obtained from the patient.

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Hanemann, J.A.C., de Carli, M.L., Dendena, E.R. et al. Rare case report of an aggressive follicular lymphoid hyperplasia in maxilla. Oral Maxillofac Surg 21, 475–481 (2017).

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