Lymphoma, which accounts for 3.5% of all oral cancers, is further divided into Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL). NHL accounts for 96% of lymphomas, and diffuse large B-cell lymphoma (DLBCL) is the most common subtype accounting for 32% of NHL. In the oral cavity, extra-nodal non-Hodgkin's lymphoma may develop in the dentoalveolar region of the maxilla or mandible. It can also mimic inflammatory lesions that occur around periodontal tissues, such as periapical granuloma and chronic osteomyelitis. Misdiagnosis of jaw lymphoma can delay appropriate treatments and worsen the prognosis. Therefore, to avoid delay in diagnosis, clinicians should identify the possible malignancy based on unusual symptoms, clinical findings, radiographic examinations, and histopathological evaluation. We present two cases of DLBCL in the right posterior mandible of a 64-year-old man who was initially misdiagnosed as acute apical abscess and in the right posterior maxilla of an 81-year-old woman who was initially misdiagnosed as chronic periodontitis. These cases demonstrate that it is important for both pathologists and clinicians to consider malignant lesions such as lymphomas in the differential diagnosis of apical radiolucency.

Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin's lymphoma, and usually showed painless neck swelling, fever, sweat, and weight loss. Although about 5% of all lymphomas appeared in the oral area, the primary maxillofacial lymphomas were rare and sometimes clinically tended to be misdiagnosed such as chronic periodontitis, osteomyelitits, etc. This study demonstrated three cases of primary DLBCL mimicking localized osteomyelitis at mandible or maxilla. A series of histological and immunohistochemical examination using different biomarkers of lymphoreticular cells were performed to characterize the neoplastic cells of DLBCL. The first case occurred in a 45 years old male exhibiting mandibular osteomyelitis and neck swelling. The second case simply showed a gingival swelling at left upper premolar area in a 55 years old male. And the third case is from an 84 years old female who felt numbness at left lower lip and had severe periodontitis involving regional alveolar bone resorption. All of three cases had experienced no systemic manifestation of lymphoreticular malignancy before the diagnosis of oral lymphoma. Immunostainings of CD3, CD20, TNFα, BCL-2, Ki-67, PCNA, and c-Myc were strongly positive in these tumor cells, while those of p53 and CD31 were slightly positive, and CD56 immunoreaction was negative. These three cases were diagnosed as DLBCL and referred to the hemato-oncology unit for treatment. Therefore, every chronic granulomatous periodontal lesion hardly cured by simple medical treatment should be carefully explored through pathological examination, and it was presumed that DLBCL is closely related to the chronic inflammatory periodontal lesions recruiting mucosa-associated lymphoid cells in older patients. It was also suggested that DLBCL be differentially diagnosed from T-cell lymphoma, Burkitt’s lymphoma, and Hodgkin’s disease, etc. with immunohistochemical determination of tumor cell subtypes as soon as possible in order to be treated with appropriate therapy.

광범위큰 B세포 림프종은 비호지킨림프종의 대표적인 아형으로 공격적 림프종이며 원발성으로 담낭에 발생한 림프 종은 일부 증례를 통한 보고가 있지만, 담낭에 단독 재발한 광범위큰 B세포 림프종은 국내에서 보고된 바가 없다. 본 증례는 상복부의 통증과 황달의 임상증상 및 복부컴퓨터단층 촬영 그리고 양전자 방출 단층촬영에서 만성 담낭염과 담낭 암으로 추정하여 수술 후 조직검사를 통해 재발한 광범위큰 B세포 림프종으로 진단할 수 있었다. 저자들은 과거 회장에 발생한 광범위큰 B세포 림프종으로 치료를 시행하여 완전완 화가 유도된 이후 다른 장기 혹은 림프절 전이 없이 단독으로 담낭에 재발한 광범위큰 B세포 림프종 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

Diagnosis of chronic myelogenous leukemia (CML) and non-Hodgkins lymphoma (NHL) have rarely been made simultaneously in the same patient. We report a rare case of a patient with CML-chronic phase who developed a concurrent Philadelphia (Ph)-negative diffuse large B-cell lymphoma. At the time of diagnosis, cytogenetic analysis of peripheral blood and bone marrow cells revealed the Ph-chromosome translocation in all examined metaphases. A lymph node biopsy showed features of diffuse large B-cell lymphoma, and fluorescence in situ hybridization (FISH) of lymph node tissue for BCR-ABL was negative. The patient was treated with R-CHOP (rituximab, cyclophosphamide, vincristine, adriamycin and prednisone) and imatinib mesylate.

Prognosis of the patients with lung cancer with lung-to-lung metastasis are known to be poor and frequently old aged persons with multiple nodules on imaging study abandon more invasive procedure including bronchoscopy and VATS (Videoassisted thoracoscopic surgery) to get tissue confirmation. Sjogren’s syndrome (SS) associated lung lesion mimicking lung cancer has a chance to have more favorable diseases including lymphoma. A 78-year-old woman with SS was admitted due to slowly progressive exertional dyspnea and multiple nodules on imaging study. She and her family gave up invasive diagnostic procedures at first due to old age but short term rapid change of dyspnea and nodules on chest CT brought out invasive procedures and diffuse large B-cell lymphoma was diagnosed. Dyspnea and nodules on imaging were improved after R-CHOP chemotherapy.

We report on a unique case of diffuse large B-cell lymphoma of the cecum, which presented as a subepithelial tumor. A 62- year-old woman with abdominal pain underwent a colonoscopy, resulting in detection of a subepithelial tumor measuring 2 cm in the cecum. We performed a right hemicolectomy with diagnostic and curative intent; histological examination and immunohistochemical staining of the resected tumor indicated a diagnosis of diffuse large B-cell lymphoma. The patient achieved complete remission with combination chemotherapy.