Non-Hodgkin’s Lymphoma

Epidemiology

Lymphomas account for 4% of all cancer diagnoses and deaths in the United States. NonHodgkin’s lymphoma (NHL) is more common than Hodgkin’s disease (HD) by a ratio of 5:1. The involvement of extranodal soft tissues and nodes in the buccal space is usually due to NHL because this entity is associated with a high incidence of extranodal involvement in the head and neck. In contrast, HD is almost always confined to nodal disease.

Clinical Findings

It is uncommon for NHL to be confined to the buccal space. Buccal space involvement is almost always part of a larger-scale disease process. NHL involving the buccal space is therefore overshadowed by cervical nodal enlargement or large extranodal masses elsewhere in the head and neck. NHL usually has a shorter history and the lesions enlarge faster than in HD.

Pathology

Histologic classification of NHL is notoriously difficult but newer techniques for classification such as immunologic phenotyping, nucleic acid analysis with flow cytometry, and molecular genetics may help explain the apparent diversity of morphological appearances. One of the most popular classifications is the Rappaport system, which is based on the pattern of involvement and cellular appearance. In general, nodular lymphomas have a more indolent course compared with the diffuse variety. Although Kaposi’s sarcoma is by far the most common tumor associated with acquired immune deficiency syndrome, there is now a recognized higher incidence of NHL as well.