# Oral Lymphoma > Oral lymphoma for NEET-MDS Oral Pathology: diffuse large B-cell lymphoma, NK/T midline lesions, Burkitt starry sky and t(8;14), and Reed-Sternberg cells. - Canonical URL: https://prepelephant.com/topics/neet-mds/oral-pathology/oral-lymphoma-mds - Exam / course: NEET-MDS · Subject: Oral Pathology - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Oral Lymphoma", PrepElephant, https://prepelephant.com/topics/neet-mds/oral-pathology/oral-lymphoma-mds ## Direct answer Lymphoma masquerades in the mouth as a boggy, painless, submucosal swelling with intact overlying mucosa — classically of the palate or gingiva — and it is overwhelmingly non-Hodgkin in type, with diffuse large B-cell lymphoma the single commonest diagnosis; the gingival and palatal masses that ulcerate late, the midfacial destructive lesions of extranodal NK/T-cell lymphoma (the modern face of "lethal midline granuloma", EBV-driven), and the rapidly expanding jaw masses of Burkitt lymphoma in a child complete the oral spectrum. Diagnosis is immunohistochemical as much as morphological — CD20 and CD3 separate B from T lineage, CD30 and CD15 identify the Reed-Sternberg cell of Hodgkin lymphoma — and handling decides the diagnosis: tissue for flow cytometry must reach the laboratory fresh, because formalin-fixed lymphoma loses the study that classifies it. ## What you must remember - Diffuse large B-cell lymphoma: commonest extranodal oral lymphoma; palate, gingiva and tongue base (Waldeyer's ring) favoured; CD45 and CD20 positive, treated with R-CHOP — the rituximab-CD20 pairing is the pharmacology fact embedded in pathology. - Extranodal NK/T-cell lymphoma, nasal type: EBV-associated, CD56 and cytotoxic-marker (granzyme B) positive; presents as necrotic ulceration destroying the palate or midface; historically "midline lethal granuloma"; treated with chemoradiation and carrying a poor prognosis. - Burkitt lymphoma: endemic African form presents as jaw destruction in children; among the fastest doubling of human tumours (often quoted at 24-48 hours); starry-sky histology of macrophages among sheets of blasts; t(8;14) translocating MYC to the immunoglobulin heavy-chain locus; sporadic and HIV-associated forms are abdominal or nodal. - Hodgkin lymphoma: Reed-Sternberg cells are CD30 and CD15 positive, CD45 negative; oral involvement is vanishingly rare though cervical nodes are commonly the first presentation. - Mantle cell (cyclin D1, t(11;14)) and follicular (BCL2, t(14;18)) lymphomas round out the translocation list examined with Burkitt's t(8;14). - Leukaemic gingival enlargement: hyperplastic, boggy, haemorrhagic gingiva with monomorphic blast infiltration — classic in monocytic AML (M4/M5); gingival swelling with pancytopenia on a routine blood picture is leukaemia until proven otherwise. - Biopsy discipline: generous incisional biopsy reaching viable tissue (superficial necrosis is non-diagnostic, especially in NK/T), with a fresh sample for flow cytometry and formalin tissue for immunohistochemistry; crushing with forceps destroys diagnostic architecture. - Staging and markers: PET-CT, lactate dehydrogenase, marrow examination; Ki-67 near 100 per cent in Burkitt. ## Working up a suspicious swelling A 62-year-old has a two-month, painless, boggy fullness of the hard palate crossing the midline, the mucosa intact but violaceous. The chairside reasoning is deliberately unglamorous: this is a submucosal mass of a minor salivary and lymphoid-rich zone, so the differential holds lymphoma alongside salivary and connective-tissue tumours, and nothing resolves it but tissue. The biopsy is planned for tissue quality: adequate depth into the mass, avoiding the necrotic core, no crush artefact, with a portion dispatched fresh to the laboratory for flow cytometry and the remainder formalin-fixed for morphology and immunohistochemistry. The panel runs CD45 positive, CD20 positive with PAX5, confirming B lineage; CD10, BCL6 and MUM1 pattern and a high Ki-67 complete a diffuse large B-cell lymphoma, and PET-CT stages it. The dentist's work continues after the diagnosis: before R-CHOP, oral sepsis is cleared — restorable teeth restored, dubious teeth extracted with platelet and neutrophil counts respected — because the mucositis, xerostomia and infection risk of chemotherapy punish every neglected focus. Alongside, a differential discipline for the midface case: a necrotic midline palatal destruction must exclude granulomatosis with polyangiitis (ANCA serology) and cocaine-related ulceration before NK/T-cell lymphoma is closed. ## How the exam frames it Three question-families recur. The marker matching: Reed-Sternberg cell CD15 and CD30; Burkitt t(8;14) and starry sky; CD56 and EBV for nasal-type NK/T; CD20 as rituximab's target — set as a matching exercise every year. The clinical mimic: the painless non-ulcerated submucosal swelling treated with antibiotics and observation for weeks; lymphoma earns its biopsy early precisely because it looks so innocent. And the handling trap: the biopsy taken without fresh tissue, leaving the haematopathologist morphology without immunophenotype — the candidate who mentions flow cytometry handling in the answer separates from the pack, as does the blood-picture reflex when gingival enlargement meets pallor or purpura. ## Frequently asked questions ### Which lymphoma most often presents in the oral cavity? Diffuse large B-cell lymphoma among non-Hodgkin lymphomas, typically as a boggy painless swelling of the palate or gingiva with intact mucosa. ### Which markers define the Reed-Sternberg cell? CD30 and CD15 positivity with CD45 negativity — the immunophenotype of classical Hodgkin lymphoma. ### What are the histological and cytogenetic signatures of Burkitt lymphoma? Starry-sky pattern of scattered macrophages amid sheets of medium-sized blasts, and the t(8;14) translocation placing MYC beside the immunoglobulin heavy-chain locus. ### Which lymphoma produces destructive midfacial lesions? Extranodal NK/T-cell lymphoma, nasal type — EBV-driven, CD56 positive — historically presented as lethal midline granuloma. ### Why is fresh tissue required at biopsy? Flow cytometry for immunophenotyping needs viable cells; formalin fixation destroys them, and lymphoma classification depends on the surface-marker study. ### What should gingival enlargement with an abnormal blood film suggest? Leukaemic infiltration — classically monocytic AML — until proven otherwise; haematology referral precedes any periodontal or surgical intervention.