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A healthy woman in her 60s was referred by her dentist to an oral surgeon for evaluation of a palatal swelling of unknown duration. The patient first presented to her dentist with a complaint of “it feels like there is something on the roof of [her] mouth.” She was never aware of the palatal lesion before her initial presentation. She denied any pain or discomfort from the site, and stated that the increasing size of the mass was what first alerted her to its presence.
The extraoral examination results were within normal limits, with no evidence of swelling, expansion, trismus, or lymphadenopathy. Intraoral examination revealed a focally ulcerated, fluctuant 2.5 × 2 × 1-cm pink-red submucosal swelling in the right palatal mucosa (Figure, A). The lesion involved almost the entire right side of the hard palatal mucosa and soft palate and terminated at the palatal midline. Imaging studies were unremarkable.
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C. Diffuse large B-cell lymphoma
Non-Hodgkin lymphoma represents a broad spectrum of hematologic malignant neoplasms that may present either with nodal or extranodal sites. The majority of non-Hodgkin lymphoma of the oral cavity present as an extranodal mass. In addition, diffuse large B-cell lymphoma (DLBCL) is the most common type and accounts for 60% of oral cavity lymphomas.1,2 It is defined by the presence of characteristic malignant lymphoid cells that have nuclei equal to or larger than a macrophage nucleus or more than double that of a standard lymphocyte nucleus.3 Although DLBCLs may affect patients of any age, most cases are reported in patients in their sixth to seventh decade of life.3 The cause of DLBCL remains unknown, and it occurs either de novo or represents an aggressive transformation of an indolent lymphoma.3
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Corresponding Author: Scott M. Peters, DDS, Division of Oral and Maxillofacial Pathology, Department of Oral and Maxillofacial Surgery, Columbia University Irving Medical Center, 630 W 168th St, PH15-1562W, New York, NY 10032 (firstname.lastname@example.org).
Published Online: January 2, 2020. doi:10.1001/jamaoto.2019.3993
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
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