Discussion :
10 to 15 percent of all patients with NHL have a T-cell lymphoma subtype and Peripheral T-cell lymphomas are one of the uncommon and aggressive subtypes of the NHL.
Despite our Case, PTCLs are most common among people older than 60 years.[5]
The etiology of PTCLs is unknown but some studies demonstrate the possibility of the association between exposure to specific viruses, such as the Epstein-Barr virus (EBV) and the
human T-cell leukemia virus-1 (HTLV-1) with PTCLs.[6]
In our case, the blood test results were negative for all HIV Ab, HTLV-1 Ab, EBV VCA-IgM, and IgG.
Rachel S. Kelly, a study showed evidence of an increased risk of NHL or multiple myeloma with exposure to lead, our case also had a history of oral opium ingestion which was highly suspected for contamination with lead. [7]
In contrast to our current case, the most common site of oral lymphoma involvement was the gingiva, and the most frequent symptoms were pain, swelling, ulceration, paresthesia, and palpable lymph nodes. [8]
The International Prognostic Index (IPI) is a scoring system for predicting overall survival which evaluates the patient by age, stage, lymph node involvement, serum lactate dehydrogenase level, and performance status. According to this scoring system, our patient scored 1 point which was identified as a low-intermediate risk. [9]
Despite the IPI low-intermediate risk, the overall 5-year survival rate of PTCL patients is less than 20% and PTCL is considered as an aggressive type of lymphoma.[10]
The recommended regimen for localized extranodal T-cell lymphoma is anthracycline-based
Chemotherapy and radiotherapy, our case also received a CHOEP regimen following radiotherapy.
Therapeutic responses to this approach have been neither adequate nor durable and followed by poor prognosis, so in recent years newer agents like monoclonal antibodies such as alemtuzumab are being investigated for PTCL treatment.[11]