Case report

Reactive lymphoid hyperplasia of the hard palate☆

Follicular lymphoid hyperplasia of the palate is a benign lymphoproliferative lesion of unknown pathogenesis. It presents usually in female patients as a painless, firm, well-demarcated, usually nonulcerated, slow-growing lesion on the palate that histopathologically may resemble a lymphoma. The authors describe a patient with this condition that was successfully treated with intralesional steroid injections. Previously reported cases were reviewed to assess the results of various treatment modalities and disease-free outcome. A nonsurgical approach to the management of follicular lymphoid hyperplasia may have better patient acceptance and satisfaction without recurrence.

Follicular lymphoid hyperplasia (FLH) of the palate is a very rare benign, proliferative process, with only 20 cases published so far in the English language literature. We describe a case, in a 55-year-old Caucasian female, who developed a swelling in the left posterior hard palate. Bony involvement was absent. Importantly, the medical history was positive for a previous non-Hodgkin lymphoma. Following incisional biopsy, histological examination revealed a vaguely nodular lymphoid proliferation composed of small well-differentiated lymphocytes. The lymphoid follicles were positive for CD20, CD79a, CD10, CD21 and BCL6, while negative for BCL2. The parafollicular areas revealed positivity for CD3, CD5, CD30, and CD15. Both areas were CD45 positive. Subsequent immunoglobulin heavy chain gene rearrangement analysis revealed a polyclonal lesion. No further treatment was instituted, and the patient is currently being followed-up every three months. This report demonstrates that FLHs are especially important due to their clinical and, occasionally, microscopic resemblance to follicular lymphomas. Morphologic and immunohistochemical analyses and molecular studies are essential to achieve accurate diagnosis and to implement appropriate management.

The follicular lymphoid hyperplasia of the palate is a very rare benign lymphoproliferative lesion that closely resembles lymphomas, clinically or histopathologically or both. A case of follicular lymphoid hyperplasia of the palate is reported. Clinically, the lesion presented as a firm, painless, nonulcerated, nonfluctuant and slowly growing swelling on one side of the palate. The biopsy showed the typical histologic features: multiple germinal centers with a rim of well-differentiated B lymphocytes together with a mixed, mainly mononuclear infiltrate with many plasmacytoid lymphocytes. The clinicopathologic features are described and integrated into a review of the 19 previously recorded cases. The diagnosis of a follicular lymphoid hyperplasia should always be considered in cases of palatal swelling.

A review of the literature and a case report of follicular lymphoid hyperplasia (FLH) of the hard palate has been presented. This entity should always be considered when confronted with a hard-palate swelling. A diagnosis of FLH generally can be made after a thorough medical and dental examination and immunocytochemical studies of the surgical specimen. Local wide excision of the tumor is suggested as the treatment of choice. During the healing period, the use of a surgical stent will give the patient comfort as the wound heals by secondary intention.