Oral and maxillofacial pathology
Online only article
Oral Hodgkin lymphoma: a wolf in wolf’s clothing

This paper was presented at the 62nd Annual Meeting of the American Academy of Oral and Maxillofacial Pathology, Kansas City, MO, May 8, 2007.
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Hodgkin lymphoma typically presents as a nodal lesion and infrequently involves extranodal sites. The English language literature contains only 7 reports of primary Hodgkin lymphoma arising in the oral mucosa in the absence of nodal disease. We report a case of primary, extranodal Hodgkin lymphoma in the palatal mucosa of a 79-year-old white female. An incisional biopsy revealed a diffuse, mixed cellular infiltrate, consisting of benign lymphocytes, plasma cells, histiocytes, and foci rich in eosinophils. Within this background was a scattering of large, atypical cells, including Reed-Sternberg forms that exhibited immunoreactivity for CD30 and CD20 and nonreactivity for CD15 and CD45RO, supporting a diagnosis of classical Hodgkin lymphoma. Positron emission tomography exhibited a single focal area of abnormal hypermetabolic activity involving the left palate area, without involvement of any other site. The clinical stage was Ann Arbor I-A. The primary tumor and submandibular and upper neck lymph nodes were treated with a 6-MV photon beam to a total dose of 4000 cGy. There was no evidence of disease at 15-month follow-up.

Section snippets

Case Report

A 79-year-old edentulous Caucasian female presented with an asymptomatic enlargement of her left palate that had been increasing in size over the preceding 3 months. Clinical intraoral examination revealed a 3.0 × 2.0–cm sessile swelling of the soft palate. The lesion exhibited a central calderalike crater with irregular, rolled borders (Fig. 1). She was afebrile and exhibited no cervical lymphadenopathy. Her medical history was significant for penicillin allergy and prior hospitalization for

Review of the Literature

Table II summarizes the clinical and histologic features of the 7 previously reported cases and the present case of primary intraoral extranodal Hodgkin lymphoma. The average age was 69 years with a range of 24 to 81 years. There was an equal gender incidence. Race was provided for only 4 of the cases, all Caucasians. The clinical lesions involved a variety of locations, including palate, tonsil, tongue, floor of mouth, buccal alveolar mucosa, buccal vestibule, and mandibular bone, with no one

Discussion

Both CHL and NLPHL are derived from germinal center (GC) B cells, with rare exceptions (see following). In a normal germinal center, activated B cells proliferate and undergo somatic hypermutation of variable region genes. Only B cells that produce high-affinity antibody to the immunizing antigen are selected to survive. Those cells that do not acquire favorable high-affinity mutations or that lose their ability to produce antibody are eliminated by apoptosis. Both CHL and NLPHL exhibit

References (47)

  • A. Tzankov et al.

    Expression of B-cell markers in classical hodgkin lymphoma: a tissue microarray analysis of 330 cases

    Mod Pathol

    (2003)
  • R. Kuppers et al.

    The origin of Hodgkin and Reed/Sternberg cells in Hodgkin’s disease

    Annu Rev Immunol

    (1998)
  • J.C. Aster

    Diseases of white blood cells, lymph nodes, spleen and thymus

  • N.L. Harris

    Hodgkin’s disease: classification and differential diagnosis

    Mod Pathol

    (1999)
  • H. Stein

    Hodgkin lymphomas: introduction

  • S.A. Pileri et al.

    Hodgkin’s lymphoma: the pathologist’s viewpoint

    J Clin Pathol

    (2002)
  • H. Stein et al.

    Classical Hodgkin lymphoma

  • K.J. Flavell et al.

    Hodgkin’s disease and the Epstein-Barr virus

    Mol Pathol

    (2000)
  • R. Kuppers et al.

    Clonality and germinal centre B-cell derivation of Hodgkin/Reed-Sternberg cells in Hodgkin’s disease

    Ann Oncol

    (1998)
  • D.D. Malis et al.

    Isolated nasopharyngeal Hodgkin’s disease presenting as nasal obstruction

    Int J Clin Pract

    (1998)
  • H. Rowley et al.

    Lymphoma presenting to a head and neck clinic

    Clin Otolaryngol Allied Sci

    (1995)
  • A. Urquhart et al.

    Hodgkin’s and non-Hodgkin’s lymphoma of the head and neck

    Laryngoscope

    (2001)
  • S.A. Rosenberg et al.

    Evidence for an orderly progression in the spread of Hodgkin’s disease

    Cancer Res

    (1966)
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