PMC4065424_01
Swelling in the anterior hard palate with surface ulceration
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F1
On examination, a single well-circumscribed swelling was seen on the anterior hard palate, ovoid in shape, measuring about 3 cm in greatest diameter, with the surface color resembling that of normal mucosa, margins were well defined and the swelling crossed the midline on the left side with surface ulceration [Figure 1].
CT scan of the maxilla, sagittal, (a) coronal (b) and axial (c) sections showing a space occupying hypodense lesion in the anterior maxilla (red arrow) with perforation and extension into the maxillary antrum. CT: Computed tomography
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F2
A contrast-enhanced computed tomography scan was performed and it revealed a large contrast-enhancing lobulated soft tissue attenuated mass measuring 57 x 45 mm in size, involving the maxillary alveolus extending up to the maxillary antrum bilaterally [Figure 2]. Extensive contiguous bone destruction was seen along with extension into the premaxillary soft tissue subcutaneous fat [Figure 2].
Photomicrograph showing centroblasts (red arrows), i.e. large atypical pleomorphic lymphocytic nucleus with multiple nucleoli (H & E stain, x400)
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F3
An incisional biopsy was done and histological examination of biopsy specimen revealed diffuse proliferation of large atypical lymphoid cells with high nuclear cytoplasmic ratio, coarse chromatin and prominent nucleoli with few abnormal mitotic figures [Figure 3].
CD20 immunostaining showing strong positivity indicating B-cell origin of lymphocytes (IHC stain, x200)
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F4
CD20 and CD45 positivity confirming the B-cell origin of lymphocytes [Figure 4]. Correlating the clinical, histopathological and immunohistological features, a final diagnosis of primary diffuse large B-cell lymphoma of anterior palate was given.
Post-chemotherapy photo showing complete resolution of the lesion followed by hypermelanosis after resolution of the swelling (red arrow)
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F5
Following chemotherapy, the palatal swelling resolved completely but areas of hypermelanosis were observed [Figure 5].