Metastasising malignant lymphoma mimicking necrotising and hyperplastic gingivostomatitis

This paper presents the case of a 65 year-old woman suffering from recurren t oral aphthoid ulcers which rapidly evolved towards hyperplastic and ulcer ated lesions over the entire floor of the mouth. The initial lesions were i nterpreted as non-specific aphthoid ulcers. Later, a tentative diagnosis of necrotising stomatitis with secondary reactive proliferating epithelial hy perplasia was made. The clinical symptoms and the immuno-phenotyping of lym phocytes circulating in the peripheral blood suggested the diagnosis of CD3 0-positive large cell anaplastic lymphoma. The biopsy showed only a pseudoe pitheliomatous hyperplasia, reactive infiltrates and no lymphoma cells. The disease ran a fulminant course leading to death within 4 weeks due to acut e gastro-intestinal bleeding. Autopsy revealed infiltrates of CD30(+) large cell anaplastic lymphoma in a submandibular lymph node, in a thrombus sten osing the right subclavian vein, in the spleen, the anterior and posterior gastric wall as well as in the depth of the tumour on the floor of the mout h. The clinical and histopathological spectrum of CD30(+) large cell anaplasti c lymphoma is considerably variable. The particular feature of pseudo epith eliomatous hyperplasia has been reported especially in CD30(+) anaplastic l arge cell lymphomas. An early correct diagnosis is rendered difficult in in sufficient biopsy size, becauses this type of lymphoma often simulates othe r inflammatory or neoplastic skin diseases. Thus, with a necrotising and hy perplastic gingivostomatitis, the diagnosis of a CD30(+) anaplastic large c ell lymphoma should be considered.