Non Hodgkin’s Lymphoma (NHL) is a cancer that starts in a lymph node and spreads to other areas of the body through the lymphatic system and the blood vessels. Prior to the AIDS epidemic, NHL generally effected older individuals (average age 67), however the incidence of NHL has increased substantially in younger persons since the beginning of the AIDS epidemic. Lesions (abnormalities) like those in the image above, especially in a younger person, may be the first indication that a patient has HIV, although it is usually accompanied by a generalized lymphadenopathy (swelling of lymph nodes all over the body).
Oral lymphoma can happen any place in the oral cavity. It most often begins as a non specific swelling of the oral tissues in a localized area. The image above shows an advanced lesion. The image below is of the same patient at an earlier stage in the disease. This image is more realistic because it shows the more nondescript presentation of a lymphoma in an edentulous palate.
It is not unusual for lesions like the one below to be misdiagnosed as a pizza burn, accidental injury or a bruise because they do not present with any of the characteristics indicative of squamous cell carcinoma which dentists are trained to recognize.
In younger persons with HIV, the swelling may be under the attached gingiva around a series of teeth, or in other parts of the mouth.
A suppressed immune response is a strong factor in the development of NHL, however persons with no history of immunosuppression (or HIV) may contract the disease. There is some evidence that one or more secondary viruses may bear the responsibility for the actual disease, the Epstein-Barr (Mononucleosis) virus once again being a prime suspect. Treatment for this condition usually involves chemotherapy and Radiation therapy.
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The most common initial symptom of NHL is painless enlargement of lymph nodes. This may occur at any site in the body, although the most frequent site is in the neck where there are a large number of lymph nodes. The disease may involve a single, or multiple groups of lymph nodes. Systemic symptoms are common, including unexplained fevers, drenching night sweats and weight loss – known as ‘B’ symptoms.
Most intra oral lesions occur in what are known as extranodal sites, which means that the swelling is not associated with a lymph node, but is composed of ectopic lymphoid tissue (ectopic means that it occurs in areas which are not it’s normal habitat).
This image shows the microscopic presentation of a lymphoma lesion. Each red dot represents a lymphocyte, which is a type of white blood cell. Ordinarily, these blood cells are found in high concentration in lymph nodes and fairly low concentration in the circulating blood. However, in lymphoma, they multiply out of control and infiltrate lymph nodes and other tissues causing enlargement of the nodes and extranodal lesions, as well as blockage of the flow of fluids in the lymphatic system. This blockage causes swelling of various parts of the body due to water retention.