Document Detail


Lymphomatoid granulomatosis presenting with gingival involvement in an immune competent elderly male.
MedLine Citation:
PMID:  22711054     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Lymphomatoid granulomatosis (LYG) represents a B cell lymphoproliferative disorder that appears to be driven by infection of the lesional cells by Epstein-Barr virus (EBV). Although not a common condition, the overwhelming majority of cases affect the lungs and mediastinal lymph nodes. Oral mucosal involvement has been documented in only one other report. We describe an 82-year-old man who developed a chronic oral ulcer following extraction of a mandibular molar tooth. Biopsy of the ulcer identified large atypical mononuclear cells that had a B cell immunophenotype and were associated with the walls of several arterioles in the sample. In situ probes for EBV-encoded small RNA showed prominent labeling of these large cells, suggesting the possibility of LYG. Imaging studies identified mediastinal and hilar lymphadenopathy on CT imaging, while PET scans showed hypermetabolic activity in the lymph nodes as well as the left mandible. Based on these findings, a diagnosis of LYG was made and the patient was treated with rituximab, an anti-CD20 monoclonal antibody, combined with a chemotherapeutic regimen consisting of etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin. After three cycles of therapy, the oral ulcer resolved significantly, as well as the areas of hypermetabolic nodal activity. Remission continued for 3 years, however the patient eventually developed non-small cell carcinoma of the lung and expired as a result of that tumor.
Authors:
Lapo Alinari; Shubham Pant; Kristin McNamara; John R Kalmar; William Marsh; Carl M Allen; Robert A Baiocchi
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2012-06-19
Journal Detail:
Title:  Head and neck pathology     Volume:  6     ISSN:  1936-0568     ISO Abbreviation:  Head Neck Pathol     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-19     Completed Date:  2013-05-16     Revised Date:  2013-07-12    
Medline Journal Info:
Nlm Unique ID:  101304010     Medline TA:  Head Neck Pathol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  496-501     Citation Subset:  IM    
Affiliation:
Division of Hematology Oncology, Department of Internal Medicine, College of Medicine and Public Health, The Ohio State University, Columbus, OH 43210, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols / therapeutic use
Carcinoma, Non-Small-Cell Lung / pathology
Epstein-Barr Virus Infections / complications*
Gingival Neoplasms / drug therapy,  pathology*,  virology
Humans
Lung Neoplasms / pathology
Lymphomatoid Granulomatosis / drug therapy,  pathology*,  virology
Male
Neoplasms, Second Primary / pathology
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