Lymphoid Lesions Flashcards
Lymphoid Lesions
Reactive Lesions - Lymphoid hyperplasia
Developmental lesions - Lymphoepithelial cyst
Neoplasms - Leukemia, Hodgkin’s Lymphoma, non-hodgkin’s lymphoma, burkitt’s lymphoma, plasmacytoma, multiple myeloma
Lymphoid Hyperplasia
Lymphoid cells proliferate to combat antigens, leading to tissue enlargement
Waldeyer’s ring - adenoid, tubal tonsil, palatine tonsil, and lingual tonsil
In the head/neck, anterior cervical lymph nodes most commonly affected
Oral Lymphoid Aggregates
Oropharnyx, soft palate, floor of mouth and lateral border of tongue
Acute: enlarged, tender, soft and movable
Chronic: enlarged, non-tender, rubbery and movable
Multiple, promineny lymphoid aggregates located in the soft palate
Sheets of small, well-differentiated lymphocytes with germinal centers
Txt: important to rule out lymphoma, completely benign, no treatment required
Lymphoepithelial Cyst
Waldeyer’s Cyst - adenoid, tubal tonsil, palatine tonsil, and lingual tonsil
oral lymphoid aggregates: oropharynx, soft palate, floor of mouth and lateral border of tongue. 50% of all cases seen in floor of mouth. Submucosa, soft/firm, smooth, non-ulcerated, yellow/white papule/nodule
txt: treated by surgical excision, recurrence is not expected
Leukemia
Leukemia represents 3.1% of all new cancer cases in the U.S.
Acute myeloid: broader age range, mostly adults
Acute lymphocytic: predominantly in children
Chronic myeloid leukemia: peak incidence 3rd and 4th decades
Chronic lymphocytic: primarily affects older adults
Philadelphia chromosome
Leukemia risk factors: pesticide, ionizing radiation, HTLV-1 virus
Common symptoms of Leukemia
Patients at increased risk for oral infections, such as candidiasis and herpes
Leukemic cells infiltrate the oral soft tissues creating diffuse gingival swelling
txt: Consists of various forms of chemotherapy
philadelphia chromosome: tyrosine-kinase inhibitor
monoclonal antibodies against CD20
Granulocytic Sarcoma
Tumor-like collection of leukemic cells in soft tissues
AKA chloroma “green tumor”
Diagnosis confirmed by the presence of poorly differentiated leukemic cells in the peripheral blood and bone marrow
Hodgkin’s Lymphoma
Usually begins in the lymph nodes
Any lymph node group is susceptible
75% affect cervical and supracervical nodes
Most commonly seen in young men
Persistently enlarging, nontender, mass. If untreated, progressively spreads
Diffuse inflammatory infiltrate interspersed with large neoplastic cells
Reed-sternberg cell: B-lymphocyte origin correspont to only 1-3% of all cells
Stage I and II: Local radiation only (may include CT)
Stage III and IV: Chemotherapy
Non-Hodgkin’s Lymphoma
Diverse and complex group of malignancies
Arise w/in lymph nodes
Tend to grow as solid masses
85% originate from B cells
Oral lesions are usually extra-nodal. May be primary or secondary disease.
Non tender and diffuse mass, usually in buccal mucosa, hard palate or gingiva
jaw lesions are usually ill-defined or ragged radiolucencies
proliferation of lymphocyte-like cells w/ varying degrees of differentiation
txt: low-grade - some recommend no treatment, intermediate to high grade (localized): RT + CT, intermediate to high grade (disseminated): CT
Burkitt’s Lymphoma
50-70% of endemic cases occur in the jaws, especially posterior maxilla
Broad sheets of lymphoid tumor cells, w/ interspersed macrophages
“starry-sky” pattern
txt: treated w/ intensive chemotherapy, 90% respont to this approach. If untreated, results in death in 4-6 weeks
Plasmacytoma
Unifocal, monoclonic proliferation of plasma cells
Normally seen in adult males (3:1 ratio)
Usually arises in the bone
Spine is the most common location (33%)
Well-defined, unilocular radiolucency or poorly-defined ragged radiolucency
Sheets of plasma cells (eccentric nuclei and stippled nuclear chromatin)
Txt: usually treated w/ radiation therapy. Few lesions can be surgically excised. About 50% will disseminate in 2-3 years
Multiple Myeloma
Multicentric malignancy of plasma cell origin
Accounts for 50% of all bone cancers (excl. metastasis)
Disease of older adults (60-70 yrs)
Bone pain, pathological fractures, fatigue (anemia), fever (neutropenia)
Multiple, well-defined, punched-out, radiolucent lesions
Screening of serum or urine by protein electrophoresis reveals abnormality
Bence-Jones protein: light chain proteins found in urine of multiple myeloma patients
Serum protein immuno eletrophoresis identifies M protein as a gamma spike
txt: usually consists of chemotherapy (60% response)
Bisphosphonates used to reduce fracture
Prognosis usually poor (25% survival)
