First manifestation of oral malignant lymphoma mimicking periodontal pathology: a case report

The oral cavity is not only a site where dental and periodontal diseases develop, but also the site of neoplastic lesions. In such cases, the variety of morphological appearances can make clinical diagnosis challenging. This article aims to highlight how early diagnosis led to the detection of a rare extranodal lymphoma presenting as isolated gingival swelling, enabling timely oncologic treatment, and long-term disease remission. A healthy, adult, patient presented with a large swelling of the periodontal tissues of lower right second molar. The lesion showed no clear correlation with the dental status of the area. It was opted for a biopsy of the enlarged tissue, avoiding periodontal treatment or extraction of the molar. Blood tests and medical diagnostic imaging were requested. Histopathological and imaging analysis revealed systemic spread, and a hypermetabolic focus in the right retromolar region corresponding to the oral lesion. This allowed for a diagnosis of extranodal non-Hodgkin lymphoma. Timely chemotherapy achieved remission and stabilization of the disease. The oral swelling disappeared spontaneously within months. Seven years after therapy, the patient is in good general health with no recurrence of lymphoma. Periodic examinations show an optimal dento-periodontal condition at the site of the molar previously affected by the neoplasm. Localized pathologic changes of periodontal tissues enabled early detection of a malignant extranodal non-Hodgkin lymphoma, ultimately leading to a timely therapy, successful outcome and patient survival. Early identification of atypical periodontal tissue alterations can facilitate the timely diagnosis of systemic disorders and malignancies affecting the periodontium. Accurate diagnosis enables cause-based therapy and improves the patient’s prognosis.