Gingival overgrowth as the initial paraneoplastic manifestation of Hodgkin's lymphoma in a child. A case report

Background: The purpose of this paper is to present the first case of gingi val overgrowth, premature root resorption, and alveolar bone loss, which pr eceded the diagnosis of a stage IVB Hodgkin's lymphoma (HL) in a 9-year-old boy, Methods: The child presented complaining of gingival pain which first appea red 3 months prior. Clinical examination revealed inflamed, hyperplastic gi ngivae, while x-ray showed premature root resorption and alveolar bone Loss . Medical work-up was significant for cervical lymphadenopathy. Gingival bi opsy, followed by lymph node resection, was performed twice. Results: Histological examination of both gingival biopsies disclosed a mix ed inflammatory infiltrate, while classical Hodgkin's lymphoma of the nodul ar sclerosis type was diagnosed from the second lymph node biopsy. Chemothe rapy was instituted with mustard-vincristine-procarbazine-prednizone and ad riamycine-bleomycine-vinblastine-dacarbazin Remission of the lymphoma was o bserved with concomitant regression of the gingival overgrowth. Conclusions: The inflammatory gingival overgrowth, premature root resorptio n of deciduous teeth, and alveolar bone loss in this case, in conjunction w ith the regression of gingival overgrowth which followed the completion of chemotherapy, are strongly indicative of a paraneoplastic manifestation of HL. The postulated mechanism for the development of the manifestation is th e constitutive activation of the transcription factor NF-kappaB. The gingiv al inflammatory reaction was probably further aggravated by the bacterial-s timulated cytokine secretion released by monocytes.