Clinicopathologic Conference
Asymptomatic nodule in the right cheek in a 65-year-old female

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Clinical Presentation

A 65-year-old African American female presented to the Harlem Hospital Center, Department of Oral and Maxillofacial Surgery, for evaluation of a persistent right buccal mass (Figure 1). The patient had incidentally discovered the lesion 3 months before presentation, and she denied any fluctuations in size or discomfort in the site. She reported no past medical history and was not taking any prescription medications at the time. Her substance history was positive for regular tobacco (4.5

Differential Diagnosis

The clinical differential diagnosis for a subcutaneous lesion of the cheek may be broadly divided into dermal, lymphoid, and mesenchymal categories.1 Commonly encountered dermal lesions at this site include the epidermoid/dermoid cyst2 and the mixed tumor of skin (chondroid syringoma).3 Lesions of lymphoid origin include reactive lymphoid hyperplasia and lymphoid neoplasms (lymphoma). Mesenchymal neoplasms, such as the lipoma, were also included in our differential diagnosis.4

Epidermoid cyst

Diagnosis and Treatment

The patient underwent surgical excision of the lesion via a transoral approach to avoid facial scarring. The gross specimen consisted of a solitary tan mass measuring 1.0 × 1.0 × 0.8 cm in size (Figure 3). Histologic examination revealed diffuse sheets of small to intermediate-sized lymphocytes within a background of densely collagenized tissue (Figure 4A). In some areas, structures resembling follicles were identified. On high-power magnification, the lymphocytic infiltrate appeared

Discussion

NHLs are a group of histologically diverse B-cell and T-cell malignancies. Most cases of NHL are diagnosed in the lymph nodes; however, extranodal lymphomas account for over a quarter of NHLs.14 Extranodal lymphomas are most commonly seen in the gastrointestinal tract, and the head and neck region is the second most common site of occurrence.17 Most patients diagnosed with extranodal head and neck lymphomas are in their fifth to seventh decades of life, and the tumor has a male predilection.14

Conclusions

Extranodal FL, a rare manifestation of NHL, often presents with nonspecific clinical signs and symptoms making proper diagnosis difficult. For this reason, early biopsy of any suspicious or unexplained oral swellings is recommended to achieve an appropriate diagnosis and effective management.

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References (25)

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    Chondroid syringoma of a cheek

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    Am Fam Physician

    (2015)
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