Oral cavity & oropharynx

Topic Completed: 1 November 2013

Revised: 24 May 2019

Copyright: 2002-2019, PathologyOutlines.com, Inc.

PubMed Search: Oral cavity[TI] lymphoma[TI]

Nat Pernick, M.D.
Page views in 2018: 1,552
Page views in 2019 to date: 1,172
Cite this page: Pernick N. Lymphoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/oralcavitylymphoma.html. Accessed October 18th, 2019.
Definition / general
  • Most commonly in Waldeyer ring in palatine and lingual tonsil
  • Usually diffuse large B cell lymphoma (68%), MALT (15%), peripheral T cell lymphoma (8%, higher % in Japan), follicular lymphoma (6%) and mantle cell (3%)
  • 2/3 are female
  • Usually EBV- (Am J Surg Pathol 1994;18:938)
  • AIDS patients often have plasmablastic lymphomas or diffuse large B cell lymphoma with poor prognosis (Hum Pathol 2002;33:153)
Gross description
  • Soft, bulky mass covered by normal or ulcerated mucosa
AIDS associated plasmablastic lymphoma
Definition / general:
  • Associated with AIDS, transplants and chemotherapy
  • Predisposition for gingival mucosa and palatal mucosa with extension to adjacent bone and abdomen, retroperitoneum, soft tissue and marrow
  • Poor prognosis: mean survival is 6 months
  • References: Hum Pathol 2002;33:392, Am J Surg Pathol 2004;28:736

Microscopic (histologic) description:
  • Monomorphic population of immunoblasts with no / minimal plasmacytic differentiation
  • Starry sky appearance at low power due to tingible body macrophages
  • Tumor cells are large with abundant, basophilic cytoplasm and occasional paranuclear hofs
  • Eccentric, round / oval nuclei with one or more prominent nucleoli; mitotic figures and apoptosis are present
  • Tumor cells infiltrate in large cohesive masses with a relatively well delineated advancing edge; no mature plasma cells

Positive stains:
  • EBV, CD38, CD138, MUM1 (100%), intracytoplasmic IgG (50%) and variable light chain restriction

Negatives stains:
  • HIV1 (but adjacent benign T cells were HIV1+), HHV8, CD20, CD45 and CD79a (may be weak, focal)

Differential diagnosis:
Diffuse large B cell lymphoma - tonsil
Definition / general:
  • Includes patients with focal follicular features that may represent follicular colonization of high grade tumor (Hum Pathol 2002;33:732)
  • In Japan / Korea, 50% are germinal center origin (BCL6+ in uniform pattern and CD10+) vs. MALT origin (Hum Pathol 2003;34:610)

Microscopic (histologic) description:
  • Involvement of pericryptal follicles in tonsils with adjacent dominant diffuse areas
  • Tumor cells are large, monomorphic, evenly spaced with clear cytoplasm and blastoid nuclei
  • Residual germinal centers are present

Positive stains:
  • Usually sporadic BCL6 (< 50% of tumor cells)

Negative stains:
Differential diagnosis:
Hodgkin lymphoma
Definition / general:
  • Very rare in oral cavity

Case reports:
Indolent T cell lymphoblastic proliferation
Case reports:
  • 35 year old man with tumor in oropharynx, myasthenia gravis and multiple recurrences without systemic dissemination over 11 year period (Am J Surg Pathol 2001;25:411)

Microscopic (histologic) description:
  • Lymphoblasts and mature lymphocytes
  • Also scattered mature and immature granulocytes

Positive stains:
Negative stains:
Molecular / cytogenetics description:
  • No T cell receptor gene rearrangement by PCR

Differential diagnosis:
Peripheral T cell lymphoma
Definition / general:
Microscopic (histologic) description:
  • Partial effacement with residual follicles surrounded by neoplastic small cells
  • Usually lymphoepithelial lesions

Molecular / cytogenetics description:
  • T cell receptor rearrangement
Primary effusion lymphoma
Case reports:
  • 42 year old HIV+ man with coexisting pleural cavity and solid tongue based lesions (both HHV8+, Hum Pathol 2004;35:632)
Back to top