EBV positive diffuse large B-cell lymphoma – a rare oral presentation

Epstein-Barr Virus (EBV) is associated with the Herpes group and is well know for its association with infectious mononucleosis. It is also associated with a variety of lymphoproliferative diseases including HIV, Burkitts Lymphoma, nasopharyngeal carcinoma, and malignant lymphomas. Malignant lymphomas are a complex and diverse disease that affects the lymphoid tissues. They are sub-divided into two main groups; Hodgkin's and Non-Hodgkin's lymphoma (NHL), but can arise out with lymph node chains – so called extra-nodal disease. Within the oral cavity extra-nodal NHL can present in jawbone, and within the oral soft tissue. They are classified following immunohistochemical features as T-cell, B-cell, or composite lymphoma. There are very few documented cases of oral presentation related to EBV+ Diffuse Large B-Cell Lymphoma. They are rarely reported in Western populations and most of the data is identified from the Asian sub-population. A recent American epidemiological study estimated that 3% of all extra-nodal Non-Hodgkin's Lymphomas were of oral cavity origin. Two Asian Studies have reported that diffuse large B-cell lymphoma (DLBCL) in the presence of EBV has a negative prognostic indicator and thus a lower survival rate. A case of a rare high grade Epstein Barr Virus (EBV) positive diffuse large B-cell lymphoma (DLBCL) that was diagnosed on oral presentation is reported. The lesion presented as a rapidly increasing palatal swelling that showed marked disease progression with poor prognosis. This report highlights the need for early investigation and work up as EBV associated DLBCL is highly aggressive and can cause systemic symptoms early, which can result in poor prognosis