Baylor University Medical Center Proceedings October 2017 - 445

Lymphoblastic lymphoma of the palate
Rakul Nambiar, MD, Geetha Narayanan, MD, DM, Lali V. Soman, MBBS, and Nandini Devi, MD

Lymphoblastic lymphomas are neoplasms of immature or precursor
lymphoid cells with no or limited bone marrow involvement, whose
clinical presentation varies according to the immunophenotype. While
mediastinal involvement is predominant in T-lymphoblastic lymphomas,
B-lymphoblastic lymphomas frequently involve nodal sites. Extranodal
presentation of B-lymphoblastic lymphomas is extremely rare. We present the case of a 49-year-old man with B-lymphoblastic lymphoma of
the hard palate. The patient was treated with the R-Hyper CVAD regimen
and is on maintenance chemotherapy. This is the first reported case of
B-lymphoblastic lymphoma arising in the hard palate.

ymphoblastic lymphoma (LBL) is a rare aggressive neoplasm of T-cell or B-cell precursors resembling acute lymphoblastic leukemia, with no or limited bone marrow
involvement, that develops more frequently in children
and young adults. Lymphoblastic lymphoma of the B-cell type
is uncommon, and extranodal presentation is even rarer. We
report what is, to the best of our knowledge, the ﬁrst reported
case of B-lymphoblastic lymphoma (B-LBL) of the hard palate.
CASE REPORT
A 49-year-old man presented with pain and swelling in the
hard palate for 3 months. Examination of the oral cavity showed
diﬀuse, soft, nontender swelling in the hard palate (Figure 1a).
There was no pallor, lymphadenopathy, or organomegaly. Computed tomography scan of the head revealed irregular rarefaction
of the anterior aspect of the hard palate. An incisional biopsy
of the lesion disclosed subepithelium diﬀusely inﬁltrated with a
monotonous population of medium to large cells with vesicular
nuclei, prominent nucleoli, and scanty cytoplasm (Figure 2).
On immunohistochemistry, the cells were positive for CD20,
CD34, Bcl2, and Tdt with an MIB labeling index of about
90%. The picture was diagnostic of B-LBL. His hemoglobin was
15 g/dL; platelets, 3.5 lakhs/mm3; and total leucocyte count,
7300/mm3. Lactate dehydrogenase was 540 U/L. His cerebrospinal ﬂuid and bone marrow studies were normal. Computed
tomography scans of the neck, thorax, abdomen, and pelvis were
normal, and he was staged as stage 1. The patient was started
on rituximab, cyclophosphamide, vincristine, doxorubicin, and
dexamethasone (R-Hyper CVAD protocol). After completion
Proc (Bayl Univ Med Cent) 2017;30(4):445-446

Figure 1. (a) Diffuse swelling in the hard palate. (b) Regression of the lesion
after one cycle of chemotherapy.

Figure 2. Monotonous population of medium to large cells with vesicular nuclei
and scanty cytoplasm (hematoxylin and eosin, 100×).

From Regional Cancer Centre, Trivandrum, India.
Corresponding author: Geetha Narayanan, MD, DM, Professor and Head,
Department of Medical Oncology, Regional Cancer Centre, Trivandrum 695011,
India (e-mail: geenarayanan@yahoo.com).
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