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Proposal of Diagnostic Approach of Periodontal Primary Non Hodgkin Lymphoma of Bone with Flow Cytometry as an Essential Diagnostic Component

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Abstract

Background

Primary bone lymphoma is a rare type of lymphoid neoplasm with favorable prognosis, where Primary Non Hodgkin Lymphoma of bone (PB-NHL) is most common with the subtype. Amongst PB-NHL, diffuse large Bcell lymphoma represents the majority of cases. The mandible is a very uncommon site of involvement, presenting as a painful bone mass with high suspicion of osteomyelitis.

Methods

We report the case of a 45-year-old male with no significant past medical history who was admitted to the hospital with a large right jaw mass and pain after recent tooth removal. The original tissue biopsy was not diagnostic, and cultures were found to be negative for microorganisms. Due to enlargement of the mass, a fine needle aspiration (FNA) was done. At the time of rapid onsite evaluation of the FNA, atypical lymphoid cells were seen, and material was obtained for flow cytometry (FC) evaluation. This revealed an aberrant clonal B-cell population. The consequent immunohistochemical evaluation of original material supported the diagnosis of PB-NHL. After chemotherapy patient improved.

Results

After an extensive English language literature review, we identified and summarized the clinical presentations, diagnostic procedures, histopathologic features, treatment methods, and outcomes of forty-two cases of periodontal PB-NHL. Based on our findings, we propose a set of clinical features at initial presentation to increase the clinical suspicion of periodontal PB-NHL for practitioners.

Conclusion

Based on our institution’s experience and the literature review conclusions, we propose the University of Texas Medical Branch diagnostic approach for PB-NHL and suggest that FNA and FC should be utilized as the essential diagnostic component. The fast and efficient diagnosis of PB-NHL can facilitate the correct treatment and sufficiently improve patient care.

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Data Availability

This manuscript has no associated data.

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Funding

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Author notes

  1. Pooja Bhakta, Ayman Youssef and Lindsay Bigham have contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA

    Pooja Bhakta, Ayman Youssef, Zachary E. Hunzeker & Maurice Willis

  2. Department of Pathology, The University of Texas Medical Branch, Galveston, TX, 77555, USA

    Lindsay Bigham, Jayati Mallick, Faisal Rawas, Jianli Dong, Suimin Qiu, Ranjana Nawgiri, Chukwuemeka-chi C. Iguh & Kirill A. Lyapichev

  3. Department of Radiology, University of Texas Medical Branch, Galveston, TX, USA

    Peeyush Bhargava & Dylan Weaver

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  1. Pooja Bhakta
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by PB, AY, LB, ZEH, and KAL. The first draft of the manuscript was written by PB, AY, LB, KAL and all authors commented on the final version of the manuscript. SQ, RN, JM and KAL were the pathologists assigned to histopathological evaluation of the specimens from this patient. PB and DW performed imaging studies evaluations. RN and CCI were participating in original cytologic evaluation of diagnostic material. FR performed the original evaluation of flow cytometrical study. JD oversaw the diagnostic molecular studies. MW was the oncologist assigned to therapy to this patient. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Kirill A. Lyapichev.

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The authors declare that they have no conflict of interest.

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This study was performed in accordance with the Declaration of Helsinki.

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The patient provided informed consent to publication.

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Bhakta, P., Youssef, A., Bigham, L. et al. Proposal of Diagnostic Approach of Periodontal Primary Non Hodgkin Lymphoma of Bone with Flow Cytometry as an Essential Diagnostic Component. Head and Neck Pathol 16, 1091–1102 (2022). https://doi.org/10.1007/s12105-022-01469-y

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