Primary extra nodal non-Hodgkin's lymphoma of the oral cavity in a young girl
A 14-year-old adolescent girl, first born to non-consanguineous parents presented with multiple gingival swellings, the most prominent one being 2 × 1 cm in the right anterior maxilla of 2 months duration []. Her birth, developmental, and family histories were insignificant. She presented to her dentist and initially received treatment for suspected gingivitis, but because of progressive nature of the swelling, she underwent gingival biopsy. The biopsy was reported as a lymphoproliferative disorder. The patient was then referred to our hospital for further management of the disease. A thorough clinical examination revealed no other significant lymphadenopathy. Investigations showed a normal complete haemogram, liver, and renal profile. A gingival biopsy was repeated at our institution and it showed fibrocollagenous tissue with sheets of atypical lymphoid cells showing high mitotic and apototic activity. Immunohistochemistry (IHC) showed CD45, CD20 positivity, and CD3 negative atypical lymphoid cells, favoring a diagnosis of NHL diffuse large B-cell type []. Subsequently, to ascertain the further extent of the disease and other organ system involvement, we proceeded with staging investigations. CSF analysis was within normal limits and cytology was negative for malignant cells. Bone marrow aspiration and biopsy done were normal. CT thorax and abdomen were also normal. However, CT PNS indicated a large homogenous soft tissue lesion in the left masticator space with erosion of the postero lateral wall of left maxillary sinus and extension of the mass lesion into the left maxillary sinus []. She was treated with chemotherapy according to the LMP-96 group B protocol. The post-cycle 4 PET-CT scan was done that showed complete resolution of the primary lesion with no demonstrable metabolic activity anywhere in the body. She received a total of 5 cycles of chemotherapy as per group B LMP 96 Protocol. She is on regular follow up and well for past 10 months.