Lymphoplasmacytic Lymphoma Involving Marrow-Containing Submandibular Heterotopic Ossification: A Case Report and Literature Review.
Lado Lako Loro, Frank-Jakob Sandbakk, Camilla Jøsok Nybø et al.
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Case in brief
A 77-year-old man presented with a gradually enlarging, increasingly uncomfortable calcified nodule in the left submandibular region. Imaging showed well-circumscribed soft-tissue ossification without continuity to the mandible; it was initially considered a calcified lymph node. Excision revealed mature lamellar bone with marrow infiltrated by an atypical lymphoplasmacytic B-cell population. Immunohistochemical and PCR findings, including IgM kappa restriction, supported lymphoplasmacytic lymphoma. Further evaluation identified a serum IgM paraprotein and sparse marrow involvement; the submandibular lesion had been the sole clinical manifestation of the otherwise occult disorder.
What made this case unusual
Lymphoplasmacytic lymphoma involved marrow-containing heterotopic ossification in the submandibular region, presenting as a lesion initially interpreted radiologically as a benign calcified lymph node.
Diagnostic / clinical pearl
A calcified head and neck lesion that appears benign on imaging may contain marrow and an occult lymphoproliferative process; histopathological and molecular assessment of excised lesions can establish the diagnosis.