Isolated Palatal Perforation Secondary to Diffuse Large B-Cell Lymphoma: A Diagnostic Challenge

Palatal perforation, a diagnostically complex condition, arises from diverse etiologies including neoplasms, infections, or inflammatory disorders. Patients often experience dysphagia, dysarthria, and social distress due to nasal regurgitation. We report a 22 year-old cachectic woman with isolated palatal perforation secondary to diffuse large B-cell lymphoma (DLBCL). She presented with a 2-month history of a painless, progressive midline ulcer unresponsive to antibiotics, culminating in a 2 cm perforation. Biopsies revealed necrotic tissue, fungal elements, and atypical lymphocytes; immunohistochemistry confirmed DLBCL (CD20+, CD3-). Imaging and labs excluded systemic involvement, infections (HIV, syphilis), and autoimmune conditions. Despite lacking classic B-symptoms, elevated lactate dehydrogenase (392 U/L) and iron-deficiency anemia suggested malignancy. This case highlights the diagnostic challenge of DLBCL mimicking benign lesions and underscores the need for multidisciplinary evaluation integrating histopathology and immunohistochemistry. Early diagnosis is critical, as R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy can improve outcomes. Clinicians should consider lymphoma in persistent palatal lesions, even without systemic signs. This report emphasizes the role of timely, targeted therapy in otolaryngologic manifestations of systemic malignancies.