Pathological Mandibular Fracture Associated With Diffuse Large B-Cell Lymphoma in HIV-Positive Patient

Abstract

This article describes the occurrence of diffuse large B-cell lymphoma in a 39-year-old human immunodeficiency virus-positive patient. The patient sought medical care complaining of increased volume in the right mandibular angle and imaging tests showed an extensive radiolucency with undefined boundaries compromising the mandibular border. After the incisional biopsy, the patient had a pathological fracture in the region, which was properly treated in a second surgical procedure using a 2.4-mm reconstruction plate. Immunohistochemical analysis revealed positive marking for CD3, CD79a, Ki67, and Epstein-Barr virus-encoded RNA. The treatment consisted of concurrent antiretroviral therapy with chemotherapy with rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone. Examinations of images (2 years postoperatively) revealed complete bone repair and absence of injury recurrence. This work is important because it describes an unusual location of diffuse large B-cell lymphoma and shows the importance of diagnosis and treatment of the injury at an early stage in order to promote the prognosis and survival of patients.

Kraniofaziale Manifestationen von systemischen Erkrankungen: CT- und MRT-Befunde

“…Dieser Befund deutet mit einem hohen Maß an Genauigkeit auf die Diagnose hin [18,21]. Als Komplikation der Erkrankung können pathologische Frakturen auftreten [22]. ▶ Abb.…”

Craniofacial Manifestations of Systemic Disorders: CT and MR Imaging Findings and Imaging Approach

“…Lymphoma demonstrates intermediate to low T2 signal intensity on MR images, with diffusion restriction secondary to high cellularity, which can suggest the diagnosis with a high degree of accuracy (18,21) ( Fig 6). Pathologic fractures can be seen as a complication (22).…”