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they are mainly classified as either hodgkin 's or non - hodgkin 's lymphoma ( nhl ) .
nhl comprises a heterogeneous group of lymphoid neoplasm with a spectrum of behavior ranging from relatively indolent to highly aggressive and potentially fatal .
only extranodal presentation of hodgkin 's disease is rare ; among nhl 's lymphomas , extranodal presentations are relatively common .
primary lymphomas of the oral cavity are uncommon . the oral cavity , including the palate , gingiva , tongue , buccal mucosa , floor of the mouth and lips is the primary site of approximately 2% of all extranodal lymphomas .
the most common clinical appearance of nhl in the mouth is a non - healing , painless ulceration .
nhl can affect both bony and soft oral tissue , with the most frequent localization being the palate and the mandible .
patient was a 50-year - old female of indian origin who presented for evaluation of a slowly enlarging anterior mandibular mass , which she stated had been present for at least 12 months .
she reported pain and swelling in association with paresthesia in the chin region for 12 - 14 months .
initially , her symptoms were thought by her dentist , to be a pyogenic granuloma and managed by excision and antibiotics .
however , the lesion recurred after six months of excision and rapidly enlarged to the present size .
clinically , the lesion appeared as sessile , soft and friable mass , which bled on palpation [ figure 1 ] .
the mass had displaced the teeth in the affected region and involved the mandibular labial sulcus . at the time of presentation ,
patient did not report any systemic symptoms and had no fever , weight loss or dysphasia .
she was not on medications at the time of presentation and was a non - drinker and a non - smoker .
intra - oral clinical view of the lesion depicting mandibular labial sulcus involvement and displacement of the adjoining teeth excisional biopsy was performed to determine the nature of the lesion .
the h and e stained soft - tissue section [ figure 2 ] revealed proliferation of lymphoblastic appearing cells that showed varying degrees of differentiation .
the section consisted of the population of monotonous proliferation of the lymphoblastic series with minimal cytoplasm .
lymphoblasts were scattered in diffuse pattern in the subepithelial connective tissue . at one area , the section was encapsulated and showed arteritis obliterans , extravasated red blood cells , collagen bundles , fibroblasts , adipocytes , chronic inflammatory cells mainly lymphocytes , calcifications , muscles fibers , eosinophilic material and bone .
the epithelium was parakeratinized stratified squamous type , which was thin and atrophic at places .
large lymphocytes are more in number than small lymphocytes ( h&e stain , 400 ) a diagnosis of primary extranodal non - hodgkin 's diffuse large b - cell type lymphoma of the gingiva with small cleaved nuclei type cells was made as cd20 marker was positive on immunohistochemistry [ figure 3 ] and patient was then referred to the oncologist for definitive management .
the oncologist confirmed that the lymphoma was localized to the anterior mandible only , without any diffuse disease or nodal involvement .
it was the recommendation of the oncologist that she should undergo four cycles of cyclophosphamide hydroxydaunorubicin oncovin prednisolone - rituximab followed by radiotherapy .
she attained a complete response and following therapy there appeared to be new healthy bone formation .
, 2 - 3% of these extranodal cases may arise primarily in the oral cavity and jaws .
it is generally accepted that the most common site of nhl in orofacial region is waldeyer 's ring .
jaw involvement by nhl is rare , but among jaw lesions , maxilla is more frequently involved than mandible .
primary lymphoma of the bone was first described by parker and jackson as primary reticular cell sarcoma of bone .
there are no characteristic clinical features when jaw bones are involved , they can present as swelling of the jaw , pain , numbness , tooth mobility or cervical lymphadenopathy .
though lymphoma of mandible is rare , it must be considered in the differential diagnosis of swellings arising in that region .
the role of surgery is for biopsy purposes and for the control of persistent or recurrent local disease .
thus , with the rising incidence of extranodal lymphomas , it has become very important for today 's dentists to not take any swellings of the orofacial region at face value , but to properly investigate its pathology and treat it judiciously .
primary non - hodgkin 's lymphoma ( nhl ) is a rare entity . 
 when it does occur , mandibular nhl typically manifests similar to an odontogenic pathology . 
 this results in delayed diagnosis and treatment . 
 we present a 50-year - old female who was erroneously treated for a pyogenic granuloma several months before the correct diagnosis of extranodal primary nhl of the oral cavity was made . 
 fortunately , the solitary bony lymphoma had not disseminated and management by chemo - radiation allowed for disease eradication and new post - treatment bone formation . 
 the purpose of this report is to describe a rare case of primary nhl of the mandible , explore the diagnosis and work - up and discuss treatment strategies . this case illustrates the need for co - operative diagnostic referrals between physicians and dentists .