Extranodal non-Hodgkin lymphoma mimicking an endodontic periapical lesion: Case report and literature review

Endodontic periapical lesions are the most commonly observed radiolucencies in this region. Nonetheless, studies highlight that between 0.65 % and 4.22 % of periapical conditions may have non-endodontic origins, including cystic formations and benign or malignant tumors. Intraosseous non-Hodgkin lymphoma (NHL) is a rare entity with nonspecific clinical and radiographic features, often causing misdiagnosis, particularly when it occurs near the apex of teeth with necrotic pulp or prior endodontic treatment. The objective of this paper is first to present a clinical case of non-Hodgkin lymphoma in a periapical location, followed by a comprehensive review of the literature focusing on the clinical, radiological, and histopathological features of this entity to improve diagnostic accuracy and guide practitioners in their therapeutic decisions. This report details a new case of non-Hodgkin lymphoma (NHL) diagnosed in a 37-year-old man who exhibited a right maxillary swelling that progressively developed over 8 months. Complementary examinations, including radiographic and histological analyses, confirmed a diagnosis of diffuse B-cell NHL. Furthermore, a literature review was conducted using databases such as PubMed, Web of Science, and Scopus to analyze previously reported cases of NHL in periapical locations. Non-Hodgkin lymphomas (NHL) are a group of disorders involving malignant monoclonal proliferation of lymphoid cells, occurring in extranodal sites in approximately 40 % of cases, particularly in the gastrointestinal tract. Intraosseous lymphomas in the head and neck region are rare, and their radiolucency in maxillary locations can mimic other benign pathologies, leading to delayed diagnosis in unaware practitioners. • Endodontic periapical lesions are the most observed radiolucencies in this region. • Non-Hodgkin lymphoma (NHL) can present nonspecific clinical and radiographic features, leading to frequent misdiagnosis as endodontic lesions. • Intraosseous lymphoma should be considered when a periapical lesion presents symptoms such as paresthesia, without dental cause.