Abstract
The patient was a 92-year-old male, who had sequestrum-like hard tissue in the left lower second premolar removed in December 2010. After 1 month, the patient had severe spontaneous pain around the surgical wound, and showed osteonecrosis of 30mm in diameter. Based on the clinical diagnosis of malignant tumor of the mandible, a biopsy was performed. No malignant cells were found in the inflammatory granulated tissue in the biopsy specimen. We diagnosed osteomyelitis of the mandible, and the patient received infection control and pain management, but the osteonecrosis slowly increased in size.
Later, the necrosis progressed to the tongue, oral floor and buccal mucosa, and the left upper jugular lymph nodes swelled rapidly in May 2011, so a biopsy was performed again. Diffuse proliferation of Reed-Sternberg-like giant cells with varying degrees of inflammatory components such as small lymphocytes, plasma cells and histocytes accompanied by necrosis and angiocentric pattern were found on histopathological examinations. Immunohistochemically, these tumor cells were positive for CD20, CD30 and EBER on in situ hybridization. A definitive diagnosis of EBV positive diffuse large B-cell lymphoma in this elderly patient was made.
We decided that systemic chemotherapy was not suitable in view of his advanced age and past illness of chronic heart failure. We provided the best supportive care including pain control, however, the patient died in August 2011.
