Oral manifestations and clinical progression of a rare double-hit B-cell lymphoma: a case report and review of the literature.

Double-hit (DH) lymphoma is a rare subtype of B-cell lymphoma characterized by the chromosomal rearrangement of c-Myc and Bcl-2, and/or Bcl-6. c-Myc is an oncogene that keeps cells proliferative. Bcl-2 and Bcl-6 grant cells antiapoptotic features. The concurrent expression of these genes and their synergistic effect make DH lymphoma refractory to traditional chemotherapy, with an extremely poor prognosis. Here, we present a case of DH lymphoma in the oral cavity, including its rapid clinical course, extensive involvement of multiple sites and organs, and response to aggressive chemotherapy. It is important for dental providers to be familiar with lymphoma's oral manifestations and consider the disease in the differential diagnosis for expansile palatal lesions. The early detection and accurate diagnosis of lymphoma by dental practitioners can help expedite proper multidisciplinary care and lead to significant reductions in patient morbidity and mortality.

Vascular Floor of Mouth Mass with Unanticipated Intracranial, Orbital, and Vertebral Associated Involvements.

We report on a case in which a blanching, unobtrusive oral growth proved to be a systemic threat. A blind, epileptic child presented with a bleeding oral floor mass of 4 weeks. Biopsy showed small, dilated vascular spaces with reactive fibroblasts. MRI indicated distribution of expansile lesions in the mandible, cranial base, and right orbit that had possibly contributed to the patient's years-long neurologic deficits. A subsequent bone scan indicated lesions in multiple axial bones. Histologic markers confirmed the presentation of a rare cystic vascular pathology. Cystic Angiomatosis is a disease of intraosseous vascular malformations with occasional visceral involvements. Oral and craniomaxillofacial cases are especially rare and presentations can involve neuropsychiatric deficits, sensory issues, and mucosal bleeding. While clinicians are often dismissive of intraoral bleeding because of the prevalence of periodontal disease, careful evaluation is nonetheless critical to rule out underlying diseases with a possibly significant systemic involvement.