case_images: PMC11378706_01
case_images: Intra-oral photography of the first endodontic consultation.
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case_images: F1
case_images: Clinical examination revealed slight vestibular swelling adjacent to the first upper left premolar with healthy mucosa (Figure 1).
case_images: Retro-alveolar radiography at the first appointment.
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case_images: F2
case_images: A 2D periapical radiograph showed an atypical bone structure (Figure 2).
case_images: Computed tomography showing a large osteolytic area between left sinus and left upper molars (10 x10 cm (668 x 668 x 668)- 0,150 mm- 90 kV-8 mA 15,117s, ROMEXIS software).
case_images: jbsr-108-1-3682-g3.jpg
case_images: PMC11378706_01_jbsr-108-1-3682-g3.jpg
case_images: F3
case_images: A CBCT scan performed three months earlier revealed a poorly defined, large osteolytic area involving the left posterior maxillary bone walls and sinus floor (Figure 3).
case_images: Histological analysis. A. A23 03155 HES_33.3x.: hematoxylin-eosin-safran (HES) coloration, original x33,3 magnification, tumor infiltration in sheets of non-cohesive cells, often crushed, of medium to large size, with barely visible cytoplasm, poorly nucleolated nucleus. Presence of apoptosis images. B. A23 03155 CD20_35 5x: immunohistochemical study using anti-CD20 antibody, original magnification x 35.5, diffuse positivity of all tumor cells in favor of proliferation of B lymphocytes C. A23 03155 KI67_17.6x: immunohistochemical study using the anti-KI67 antibody, original magnification x17.6, highlighting a high proliferation index, in favor of an aggressive B lymphoma.
case_images: jbsr-108-1-3682-g4.jpg
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case_images: F4
case_images: Histological analysis showed bone infiltrated by large cells with scant cytoplasm and round nuclei (Figure 4), leading to a diagnosis of primary high-grade large B-cell non-Hodgkin's lymphoma.
case_images: PET-SCAN after diagnosis and three months later after treatment.
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case_images: F5
case_images: The patient underwent six courses of chemotherapy and two cycles of high-dose methotrexate to prevent cerebrospinal fluid relapse (Figure 5).
case_images: Radiography retro-alveolar post treatment (note the new densification around teeth).
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case_images: PMC11378706_01_jbsr-108-1-3682-g6.jpg
case_images: F6
case_images: After treatment, the patient reported no symptoms, and oral examination showed normal bone structure (Figure 6).