Background : Rare case of Hodgkin Lymphoma presenting as non-healing dental extraction socket.

Method : Case presentation and discussion.

Results : A 54 year old male presented to the King’s County Hospital Oral and Maxillofacial Surgery clinic, (Brooklyn, New York) 6 months after extraction of tooth#30 with diaphoresis, right submandibular swelling, erythematous exophytic mass of the right mandible. No cervical lymphadenopathy noted.

Biopsy : Infiltration of mixed mononuclear cells; Reed-Sternberg cells (stained positive for cd20 and cd30).

Diagnosis : Hodgkin lymphoma, (mixed cellularity type).

Staging : CT scan showed bony erosion of mandible; Gallium-67 scan showed isolated uptake in right mandible region. Bone marrow biopsy showed hypercellularity with no disease in marrow. Ann Arbor Stage1e (extranodal). Adriamycin was withheld due to hypokinetic left ventricle (ejection fraction 25%). Treatment with 4 cycles of CHOPP (Vincristine/Cyclophosphamide). Lesion regressed to 0.5 cm. Six months after diagnosis, patient experienced acute mental status change and was found to have splenomegaly and increased intracranial pressure. CT and brain biopsy yielded necrotic brain tissue. Patient expired two weeks later- no post mortem done.

Discussion : Hodgkin Lymphoma is rare in the mandible, with only six cases documented in the literature. Two of these cases were advanced StageII and StageIII disease and patients succumbed to their disease before 7 months. Four of these cases involved patients with previously diagnosed Hodgkin lymphoma. In only one of these documented cases was the lesion a solitary Ann Arbor StageI lesion. This is one of two documented solitary Hodgkin lymphomas central in the mandible. What is unique about case is how the patient presented to the OMFS clinic with a non-healing extraction socket.

Conclusions : This is a rare presentation of Hodgkin lymphoma in mandible. Hodgkin lymphoma central in the mandible is associated with poor survival in three of seven known cases.

Key words Hodgkin lymphoma; central in mandible