01 August 2022

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Palatal swelling: a clinical case

Author: Riccardo Mauro Bonacina

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Patient AB, a 46-year-old male, comes to our observation complaining of an increase in volume at the palatal level for about a month. The systemic anamnesis shows a moderate asthenia and hypertension in drug treatment. The patient smokes 10 cigarettes a day. On physical examination the mucous membranes appear intact, ulcerative or erythroplastic lesions are not evident. Oral hygiene is poor and pigmented tartar is present. There are destructive cavities from 17-23-26-27-37-46. Element 23 has positive vitality. Moderate to severe generalized periodontitis is present. On palpation the lips, cheeks and oral floor do not show any new growths. Lingual mobility is preserved and the doctoral students are hurt. The latero-cervical and pre-auricular lymph nodes do not show significant dimensional increases. At the palatal level there is a bilobed tumefaction (fig. 1) that involves almost all the left hemi-palate. The mucosa is hyperemic and upon palpation the neoformation is soft-parenchymatous. No symptoms are present either spontaneous or on palpation of the lesion. There are no obvious fistulas. A radiographic survey is performed which allows the periapical lesions of 24-25-26-27 to be highlighted. The presence of numerous potential odontogenic infectious causes presents an initial hypothesis as an infective-inflammatory reactive lesion, but the differential diagnosis must also consider systemic pathologies such as hematological or oncological diseases, both primary and secondary of the oral cavity.  

DIAGNOSIS AND CARE
In agreement with the patient, a local aspiration was performed, after local anesthesia, to verify the contents of the lesion. The needle aspiration did not lead to any collection of liquid blood or purulent material. Given the absence of liquid content, and always in agreement with the patient, a biopsy was performed (fig. 2). The histological analysis made it possible to establish a diagnosis of oral localization of follicular lymphoma. The presence of other systemic localizations has confirmed the diagnosis of follicular lymphoma III Ann Arbor staging.
Follicular lymphoma is a malignant neoplasm of the lymphatic system belonging to the group of non-Hodgkin's lymphomas. It belongs to the indolent forms, therefore to slow growth. The follicular histotype is the most frequent (70%) with a mean age at diagnosis of 60 years. It is characterized by the presence in 80-90% of cases of the typical chromosomal alterations t (14; 18) (q32; q21). The patient was therefore treated by hematology colleagues with chemotherapy according to the R-CHOP scheme, with complete remission of the pathology (fig. 3). The six-monthly dental checks have allowed to verify after more than 2 years the absence of local recurrences to the oral cavity. Even the subsequent hematological controls confirmed the absence of systemic recurrences.