Proposal of Diagnostic Approach of Periodontal Primary Non Hodgkin Lymphoma of Bone with Flow Cytometry as an Essential Diagnostic Component

Pooja Bhakta, Ayman Youssef, Lindsay Bigham, Jayati Mallick, Peeyush Bhargava, Faisal Rawas, Dylan Weaver, Zachary E. Hunzeker, Jianli Dong, Maurice Willis, Suimin Qiu, Ranjana Nawgiri, Chukwuemeka chi C. Iguh, Kirill A. Lyapichev

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: Primary bone lymphoma is a rare type of lymphoid neoplasm with favorable prognosis, where PrimaryNon Hodgkin Lymphoma of bone (PB-NHL) is most common with the subtype. Amongst PB-NHL, diffuse large Bcelllymphoma represents the majority of cases. The mandible is a very uncommon site of involvement, presentingas a painful bone mass with high suspicion of osteomyelitis. Methods: We report the case of a 45-year-old male with no significant past medical history who was admitted to the hospital with a large right jaw mass and pain after recent tooth removal. The original tissue biopsy was not diagnostic, and cultures were found to be negative for microorganisms. Due to enlargement of the mass, a fine needle aspiration (FNA) was done. At the time of rapid onsite evaluation of the FNA, atypical lymphoid cells were seen, and material was obtained for flow cytometry (FC) evaluation. This revealed an aberrant clonal B-cell population. The consequent immunohistochemical evaluation of original material supported the diagnosis of PB-NHL. After chemotherapy patient improved. Results: After an extensive English language literature review, we identified and summarized the clinical presentations, diagnostic procedures, histopathologic features, treatment methods, and outcomes of forty-two cases of periodontal PB-NHL. Based on our findings, we propose a set of clinical features at initial presentation to increase the clinical suspicion of periodontal PB-NHL for practitioners. Conclusion: Based on our institution’s experience and the literature review conclusions, we propose the University of Texas Medical Branch diagnostic approach for PB-NHL and suggest that FNA and FC should be utilized as the essential diagnostic component. The fast and efficient diagnosis of PB-NHL can facilitate the correct treatment and sufficiently improve patient care.

Original languageEnglish (US)
Pages (from-to)1091-1102
Number of pages12
JournalHead and Neck Pathology
Issue number4
StatePublished - Dec 2022


  • Excisional biopsy
  • Fibrosis
  • Fine-needle aspiration
  • Flow cytometry
  • Immunohistochemistry
  • Mandible
  • Non-Hodgkin lymphoma
  • Osteolytic lesion
  • Primary bone lymphoma
  • Rituximab

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Otorhinolaryngology
  • Oncology


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