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 gingival overgrowth, premature root resorption, and alveolar bone loss, which preceded 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 appeared 3 months prior. Clinical examination revealed inflamed, hyperplastic gingivae, while x-ray showed premature root resorption and alveolar bone loss. Medical work-up was significant for cervical lymphadenopathy. Gingival biopsy, followed by lymph node resection, was performed twice.


RESULTS
Histological examination of both gingival biopsies disclosed a mixed inflammatory infiltrate, while classical Hodgkin's lymphoma of the nodular sclerosis type was diagnosed from the second lymph node biopsy. Chemotherapy was instituted with mustard-vincristine-procarbazine-prednizone and adriamycine-bleomycine-vinblastine-dacarbazine. Remission of the lymphoma was observed with concomitant regression of the gingival overgrowth.


CONCLUSIONS
The inflammatory gingival overgrowth, premature root resorption of deciduous teeth, and alveolar bone loss in this case, in conjunction with 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 the constitutive activation of the transcription factor NF-kB. The gingival inflammatory reaction was probably further aggravated by the bacterial-stimulated cytokine secretion released by monocytes.
Nicolatou-Galitis
O
O
Department of Oral Pathology and Surgery, School of Dentistry, University of Athens, Greece. nicolatou.galitis@mailcity.com
Papadaki
T
T
Moschovi
M
M
Moshovi
M
M
Kamma
J J
JJ
van Vliet-Constantinidou
C
C
Tsoumakas
C
C
Kattamis
A
A
Tzortzatou-Stathopoulou
F
F
D016301:Alveolar Bone Loss / Q000209:etiology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001706:Biopsy; D001761:Bleomycin / Q000008:administration & dosage; D002648:Child; D003606:Dacarbazine / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005885:Gingival Hyperplasia / Q000209:etiology; D019214:Gingival Overgrowth / Q000209:etiology*; D006689:Hodgkin Disease / Q000150:complications*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008466:Mechlorethamine / Q000008:administration & dosage; D009367:Neoplasm Staging; D010257:Paraneoplastic Syndromes / Q000209:etiology*; D011241:Prednisone / Q000008:administration & dosage; D011344:Procarbazine / Q000008:administration & dosage; D012074:Remission Induction; D012391:Root Resorption / Q000209:etiology; D014094:Tooth, Deciduous / Q000473:pathology; D014747:Vinblastine / Q000008:administration & dosage; D014750:Vincristine / Q000008:administration & dosage
D001761:Bleomycin; D011344:Procarbazine; D008466:Mechlorethamine; D014750:Vincristine; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin; D011241:Prednisone