DOI: https://doi.org/10.36347/sjmcr.2026.v14i05.014

Pages: 924-927

Primary bone lymphoma (PBL) of the mandible represents an exceptionally rare extranodal manifestation of non-Hodgkin lymphoma, often posing a significant diagnostic challenge that can delay critical intervention. This report details the case of a 44-year-old male smoker presenting with a rapidly progressive, painful swelling of the right posterior mandible. Clinical and radiographic evaluations revealed a 5.5 cm aggressive osteolytic lesion characterized by cortical destruction and soft tissue extension, accompanied by regional lymphadenopathy. An incisional biopsy followed by histopathological and immunohistochemical analysis confirmed a diagnosis of "double hit" diffuse large B-cell lymphoma (DLBCL), germinal B-cell subtype, classified as Ann Arbor stage IIE. Given the nonspecific clinical presentation which frequently mimics osteomyelitis or primary bone malignancies definitive diagnosis relies heavily on immunohistochemistry to identify aggressive subtypes like the double hit rearrangement (MYC and BCL2). This case emphasizes the necessity of including PBL-DLBCL in the differential diagnosis of mandibular masses and highlights the vital role of a multidisciplinary approach in ensuring early recognition and referral to hematology-oncology units to improve patient outcomes.