Primary extra-nodal non-Hodgkin’s lymphoma affecting mandibular bone: a case report

Non-Hodgkin's lymphoma (NHL) is the second most common non-epithelial malignant tumor in the cervicofacial region. Among aggressive NHL, the most common histological type is diffuse large B cell lymphoma (DLBCL). A 44-year-old man presented himself at the oral surgery consultation for the development of isolated dental mobilities associated with mandibular osteolytic lesion. The extraoral examination showed nothing. The neurological examination did not reveal dysesthesia or hypoesthesia. The endo-buccal examination showed an erythematous gum, mobility stage 3 of teeth #42 to 35 with positive pulp sensitivity tests on teeth #34 to 47 and no increased probing depth. The X-rays found homogeneous rounded monogeodic osteolytic lesion extending from teeth #42 to 35 with thinning of the cortical layer. The anatomopathological results of a partial biopsy of the parasymphyseal region found a diffuse large B cell lymphoma of GC phenotype. The patient was referred to the department of oncohematology and treatment was only medical with R-CHOP 21 type immunochemotherapy for 6 cycles. Primary intraosseous localization of non-Hodgkin's lymphoma is rare. The clinical and radiological signs of this malignant tumor pathology are not specific and make its positive diagnosis particularly difficult. In case of uncertainty, an appropriate radiological examination combined with a partial biopsy is essential.