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]