the occurrence of the non - hodgkin 's lymphoma ( nhl ) in the oral cavity in patients with acquired immune deficiency syndrome ( aids ) has been reported by various authors . however , only three reports could be traced in which the oral manifestations of nhl were discussed in detail . nhl is rarely seen in the oral cavity , and the gingiva is one of the uncommon intraoral sites to be involved . this paper reviews a case of primary nhl , which presented as a gingival mass in a hiv - infected patient . a 28-year - old male patient reported to the dental clinic with a complaint of a swelling in the lower front teeth region since 2 months . the patient had been aware of a gradual increase in the size of the swelling , but had not experienced any local discomfort or bleeding . from his social history , the patient belonged to a high - risk group as he was found to be promiscuous . he smoked approximately 20 cigarettes a day since 10 years and he was also a known alcoholic for the same period . extra - oral examination at the first visit revealed submandibular cervical lymphadenopathy , but no obvious facial asymmetry was noted . on intraoral examination , a reddish multilobular tissue mass of size 3  4 cm was noted involving both the labial and lingual aspect of the lower anterior teeth . lingually , it involved the sublingual region up to the lingual frenum [ figure 1 ] . intraoral picture showing the gingival mass intraoral periapical radiograph ( iopa ) revealed severe bone loss up to the periapical region of mandibular incisors along with ill - defined borders [ figure 2 ] . iopa radiograph revealing severe bone loss in relation to mandibular incisors the microscopic examination revealed a wedge of oral mucosa containing a dense , diffuse proliferation of malignant lymphoid cells in the connective tissue stroma . the neoplastic cells appear to be uniformly dark , round , and moderately differentiated and were also found to be infiltrating the adjacent tissues [ figure 3 ] . the neoplastic cells consisted of abundant pale cytoplasm , large vesicular nuclei with chromatin clumping . photomicrograph showing dense , diffuse infiltration of malignant lymphoid cells in the connective tissue stroma ( h and e , 4 ) photomicrograph showing neoplastic lymphoid cells ( h and e , 40 ) the above features in correlation with clinical and radiological pictures were suggestive of a diffuse type primary extranodal large - cell nhl . nhl is the second most common hiv - associated tumor after kaposi 's sarcoma , the risk of getting nhl being 60 times greater in patients with hiv disease than in otherwise healthy persons . it is perhaps more frequent in homosexual males and injecting drug users than in other patients liable to hiv disease . the nhls commonly involve the oropharyngeal lymphoid tissue comprising of waldeyer 's ring but only occasionally involve other oral tissues . the gingiva is one of the rarest intraoral sites and only isolated cases have been reported . this is partially accounted for by the fact that lymphoid tissue is not normally found in the gingiva . in the largest series of intraoral lymphoma cases reported , not a single case of gingival involvement has been reported . the diagnosis of malignant lymphoma can only be made by microscopic examination of the biopsy specimen . however , the incidence of malignancy in patients who are immunodeficient has been reported as 10,000 times that of the general age matched population . the incidence of diffuse large cell lymphomas is 0.3% in younger age and has a relative survival rate of 42.9% after 5 years . primary immunodeficiency syndromes such as chediak - higashi , wiscott - aldrich , and ataxia - telangiectasia are associated with an increased risk of developing lymphoma . generally , radiotherapy is used to treat local lesions , while chemotherapy is used for disseminated disease . autologous hematopoietic stem - cell transplantation ( hsct ) after high - dose chemotherapy has evolved as part of the standard of care for many patients with nhl . the success of this treatment modality hinges on collection of sufficient hematopoietic stem cells ( hsc ) for transplantation . approximately 1030% of patients are unable to collect the minimum number of hsc , defined as 2  10 cd34 cells / kg , to support high - dose chemotherapy and autologous hsct . plerixafor given either alone or with granulocyte colony - stimulating factor ( g - csf ) has been reported in phases i and ii clinical studies to significantly increase the number of peripheral blood cd34 cells and cd34 cell collection . adolescents ( age 1521 years ) compared with younger children with mature b - cell nhl have been historically considered to have an inferior prognosis . according to french  american  british mature b - cell lymphoma 96 ( fab lmb 96 ) trial , the ldh level at diagnosis , mediastinal disease , and combined bone marrow - positive / cns - positive involvement are independent risk factors in children with mature b - cell nhl . it was reported that between 4% and 10% of patients affected by aids will develop nhl . nhl in patients with aids confers a poor prognosis , not only because of the sequelae of progressive lymphoma , but also because of an increased incidence of opportunistic infection . median survival was 34 months in immunocompetent vs. 9 months in hiv - positive patients . there was no apparent difference in survival with regimens more intensive than cyclophosphamide , doxorubicin , vincristine , and prednisone ( chop ) . the intraoral nhl commonly shows a strong resemblance to acute necrotizing and inflammatory lesions of the gingiva . thus , clinical diagnosis may be difficult to make , especially when it exhibits primary with solitary manifestations . it is , therefore , imperative that clinicians include nhl in the differential diagnosis of oral lesions in persons belonging to the high - risk groups . therefore , it has been suggested that inclusion of nhl in differential diagnosis of intraoral soft tissue masses in suspected hiv cases . importance of early diagnosis to ensure appropriate treatment and to develop awareness among health care workers , especially dentists , of the increased risk of oral nhl among hiv population appears to be imperative .
non - hodgkin 's lymphoma ( nhl ) is seldom seen in the oral cavity , and has been reported with some frequency in hiv - positive patients . 
 oral hiv - related lymphomas exhibit an aggressive course and can mimic other oral tumors and infections that make early recognition and diagnosis difficult . 
 this paper presents a case of nhl on the gingiva of a 28-year - old hiv - positive male patient .