Page 51 - AAOMP Meeting 2019

POSTER ABSTRACTS - TUESDAY, JUNE 11, 2019

#53 CD30-POSITIVE T-CELL LYMPHOPROLIFERATIVE DISORDER: A CHALLENGING
DIAGNOSIS OF A COMPLEX ENTITY
Dr. Paras Patel (Texas A&M University College of Dentistry), Dr. Diana Lois (Implants and Oral
Surgery), Dr. Beth Wright (Surgical Pathologists of Dallas), Dr. Yi-Shing Lisa Cheng (Department of
Diagnostic Sciences, Texas A&M University College of Dentistry, Dallas, Texas)
CD30-positive lymphoproliferative disorder is an enigmatic entity that consists of a spectrum of pathologic
processes that span from self-healing mucocutaneous nodular ulcerations to lymphoma. Combined clinical,
histopathological, and molecular features are necessary to further subclassify this disease process. We
report a case of a 49 year- old Caucasian male who presented with recent onset of oral mucosal
ulcerations. Clinical examination revealed multiple large indurated ulcers affecting the tongue as well as
buccal and labial mucosal surfaces. The patient’s medical history was significant for type II diabetes,
hypertension, hypercholesterolemia; and the patient admitted to tobacco, alcohol, and marijuana use.
Incisional biopsies were taken from the lower labial mucosa and ventral tongue. The histologic findings
revealed ulcerative lesions with an atypical inflammatory cell infiltrate consisting of clusters of large cells,
occasional mitoses, and infiltration deeper within the skeletal muscle. Special stains for AFB and PAS,
along with immunohistochemical studies for CD30 as well as in-situ hybridization (ISH) for EBER were
performed. AFB and GMS revealed no evidence of causative organisms, and EBER ISH was negative within
the inflammatory cell population. However, CD30 was positive in the large atypical cells. Therefore, a
hematopathology consult was requested and the case was subsequently referred to the National Cancer
Institute for further classification. Further immunohistochemical studies revealed that the atypical cells were
positive for CD2, CD3, CD4, CD5, CD30, TIA1, Granzyme B, and Perforin. Additionally, molecular
analysis for T-cell receptor gene rearrangements were performed and revealed a significant clonal T-cell
population. A final diagnosis of CD30-positive T-cell lymphoproliferative disorder was rendered. The
patient was referred to a medical oncologist for further evaluation. Interestingly, all of the lesions showed
evidence of healing during the patient’s post-operative visits, without initiation of therapy. Herein, we discuss
CD30-positive T-cell lymphoproliferative disorder, the diseases it encompasses, their histopathologic
features, and their prognoses.

#54 EXTRANODAL PALATAL MANIFESTATION OF A FOLLICULAR LYMPHOMA: A
CASE REPORT
Ms. Sara Sternbach (New York University College of Dentistry), Ms. Rachelle Wolk (New York
University College of Dentistry), Dr. Sonal Shah (New York University College of Dentistry), Dr. Arthi
Kumar (New York University College of Dentistry), Dr. Denise Trochesset (New York University
College of Dentistry)
Background: Follicular lymphoma (FL) is a low-grade subtype of Non-Hodgkin’s lymphoma (NHL), making
up approximately 20% of all lymphomas. Follicular lymphomas predominantly affect adults and are named for
the follicular growth pattern of the cells. While FL is an indolent variant of non-Hodgkin’s lymphoma,
transformation into a more aggressive, high-grade subtype, typically diffuse large B-cell lymphoma
(DLBCL), is seen in approximately 30% of cases. As with most cancers, FL may be assigned a grade of 1, 2,
or 3 based on the number of centroblasts identified under the microscope at highest power. FL most commonly
involves the lymph nodes, with presentation in the oral cavity being rare. When present in the soft tissues of
the oral cavity, lesions typically occur on the hard palate, soft palate, tongue, buccal mucosa, and gingiva.
Current treatment options, depending on the grade, include: immunomodulators, immunotherapy with or
without chemotherapy, and involved-site radiation therapy.
Case: An 89-year-old male presented to his oral surgeon with a right palatal swelling measuring 3.5 x 3.0 cm.
The patient reported this swelling to be present for greater than five months and had been told previously by an
ENT that “it’s not cancer”. The lesion was firm to palpation. Upon obtaining a CBCT, no bone lysis was noted,
confirming the lesion was confined to the soft tissue. Scalpel biopsy results confirmed the diagnosis to be
follicular lymphoma, follicular pattern, grade 1-2 of 3.
Conclusion: This case emphasizes the need for proper diagnosis including medical history and appropriate
biopsy techniques. Since follicular lymphoma has a risk of transformation into more aggressive types of
lymphomas, early diagnosis is imperative. Clinicians should be aware of the various extranodal presentations
of lymphomas and unusual lesions and swellings should not be ignored/prematurely dismissed.