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Lv J, Jiang Y, Yu T, Gao S, Yin W. Clinical characteristics and prognostic analysis of primary extranodal non-Hodgkin lymphoma of the head and neck. Aging (Albany NY) 2024; 16:6796-6808. [PMID: 38604163 PMCID: PMC11087136 DOI: 10.18632/aging.205726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 02/29/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE Primary extranodal non-Hodgkin's lymphoma (PE-NHL) of the head and neck is the second common site of extranodal lymphoma, accounting for approximately one-third of all extranodal non-Hodgkin's lymphoma (E-NHL). However, in recent years, large-scale PE-NHL case studies in China and worldwide are rare and not comprehensive enough. This work analyzed the clinical manifestations, pathological features, immunophenotypes and diagnosis of PE-NHL, as well as the factors affecting the treatment and prognosis. METHODS A retrospective study was performed on 74 patients who were diagnosed with head and neck PE-NHL and treated for the first time. The clinical manifestations, pathological features, and immunophenotypes were summarized, and the factors related to the treatment and prognosis were analyzed. RESULTS The most common site of this disease was the Waldeyer's ring, followed by the nasal cavity. Diffuse large B-cell lymphoma was the most common type, followed by extranodal NK T-cell lymphoma nasal type. The 1-year, 2-year, and 5-year progression-free survival (PFS) rates were 76.4%, 67.9%, and 59.3%. The 1-year, 2-year, and 5-year overall survival (OS) rates were 89.4%, 85.6%, and 63.2%. ECOG score ≥ 2, Ann Arbor stage III or IV and IPI risk stratification identifying patients as the high-risk group were independent risk factors affecting the OS of patients with PE-NHL of the head and neck. CONCLUSIONS The most common site of PE-NHL in these Chinese patients was the Waldeyer's ring, but the incidence in the nasal cavity was higher than that reported in Western countries. Radiotherapy combined with chemotherapy had better efficacy than chemotherapy alone, and the prognosis depended on the ECOG score and clinical stage. IPI had a better prognostic value in patients in the high-risk group of head and neck PE-NHL.
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Affiliation(s)
- Jiamu Lv
- Department of Otolaryngology Head and Neck Surgery, First Hospital of Jilin University, Changchun, China
| | - Yining Jiang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Tingting Yu
- Department of Otolaryngology Head and Neck Surgery, First Hospital of Jilin University, Changchun, China
| | - Shengrui Gao
- Department of Otolaryngology Head and Neck Surgery, First Hospital of Jilin University, Changchun, China
| | - Wanzhong Yin
- Department of Otolaryngology Head and Neck Surgery, First Hospital of Jilin University, Changchun, China
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2
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Varedi D, Maan P, Bruckner JJ, Carlson M, Wei J, Bhanu S, Bui D. Enlarging premaxillary mass: A unique manifestation of extranodal diffuse B-cell lymphoma. Radiol Case Rep 2023; 18:3759-3763. [PMID: 37644991 PMCID: PMC10460950 DOI: 10.1016/j.radcr.2023.07.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 08/31/2023] Open
Abstract
Lymphomas are the most common nonepithelial malignancy in the head and neck region. Among these, non-Hodgkin Lymphoma (NHL) is the most prevalent, and diffuse large B-cell lymphoma (DLBCL) is the most common histologic subtype. NHL is known for its propensity for extranodal involvement, which can affect any anatomical location. The presence of perineural spread is frequently encountered in head and neck malignancies, including lymphomas. We report a case of a 40-year-old male with an enlarging infraorbital facial mass with associated erythema, pain, and paresthesia, which was subsequently found to be extranodal DLBCL with retrograde perineural spread along the infraorbital nerve.
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Affiliation(s)
- Daryush Varedi
- Department of Radiology, Riverside Community Hospital, Riverside, CA, USA
| | - Pavandeep Maan
- Department of Radiology, Riverside Community Hospital, Riverside, CA, USA
| | - Jacob J Bruckner
- Department of Radiology, Riverside Community Hospital, Riverside, CA, USA
| | - Michael Carlson
- Department of Radiology, Riverside Community Hospital, Riverside, CA, USA
| | - Justin Wei
- Department of Radiology, Riverside Community Hospital, Riverside, CA, USA
| | - Shiv Bhanu
- Department of Radiology, Riverside Community Hospital, Riverside, CA, USA
| | - Duy Bui
- Department of Radiology, Riverside Community Hospital, Riverside, CA, USA
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3
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Peng J, Qiu J, Cheng D, Rao Y, Mao M, Qiu K, Li J, Chen F, Liu F, Liu J, Mu X, Yu W, Zhang W, Xu W, Zhao Y, Ren J. Comparison of Primary B/NKT Non-Hodgkin Lymphomas in Nasopharynx, Nasal Cavity, and Paranasal Sinuses. Otolaryngol Head Neck Surg 2023; 168:1107-1118. [PMID: 36939485 DOI: 10.1002/ohn.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/26/2022] [Accepted: 10/18/2022] [Indexed: 02/11/2023]
Abstract
OBJECTIVE We aimed to compare clinical and survival differences between B-cell (B-NHL) and NKT-cell non-Hodgkin lymphomas (NKT-NHL) located in the nasal cavity (NC), nasopharynx, and paranasal sinuses, which are always categorized as one sinonasal type. STUDY DESIGN Patients diagnosed with primary B-NHL and NKT-NHL in the nasal cavity, nasopharynx, and paranasal sinuses from Surveillance, Epidemiology, and End Results (SEER) database were included (1975-2017). SETTING Population-based cohort study. METHODS We conducted univariate and multivariate Cox regressions and Kaplan-Meier analysis to examine survival outcomes of B/NKT-NHL in the nasal cavity, nasopharynx, and paranasal sinuses, respectively. RESULTS Overall, most B-NHL cases originated from the nasopharynx, while the majority of NKT-NHL cases occurred in the nasal cavity. Notably, the cancer-special survival (CSS) outcomes improved significantly in all sinonasal B-NHL cases over time, whereas no such improvement trend was observed in each sinonasal NKT-NHL type. Additionally, increasing age was linked with an elevated risk of death in B-NHL, particularly in the nasal cavity (Hazard ratio [HR]: 3.37), rather than in NKT-NHL. Compared with B-NHL, the adverse effect of a higher stage on CSS was more evident in NKT-NHL, particularly in its nasopharynx site (HR: 5.12). Furthermore, radiotherapy was beneficial for survival in patients with sinonasal B-NHL and NKT-NHL, except in the nasopharynx NKT-NHL. However, chemotherapy has only been beneficial for CSS in patients with paranasal sinuses B-NHL (HR: 0.42) since 2010, rather than in other types of B/NKT-NHL. CONCLUSION Although B-NHL and NKT-NHL in the nasal cavity, nasopharynx and paranasal sinuses have similar anatomical locations, their clinicodemographics and prognoses are largely different and should be treated and studied as distinct diseases.
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Affiliation(s)
- Jiajia Peng
- Department of Oto-Rhino-Laryngology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Jianqing Qiu
- Department of Oto-Rhino-Laryngology, West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Danni Cheng
- Department of Oto-Rhino-Laryngology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Yufang Rao
- Department of Oto-Rhino-Laryngology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Minzi Mao
- Department of Oto-Rhino-Laryngology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Ke Qiu
- Department of Oto-Rhino-Laryngology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Junhong Li
- Department of Oto-Rhino-Laryngology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Fei Chen
- Department of Oto-Rhino-Laryngology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Feng Liu
- Department of Oto-Rhino-Laryngology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Jun Liu
- Department of Oto-Rhino-Laryngology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaosong Mu
- Department of Oto-Rhino-Laryngology, Langzhong People's Hospital, Sichuan, Langzhong, China
| | - Wenxin Yu
- Department of Oto-Rhino-Laryngology, Suining People's Hospital, Sichuan, Suining, China
| | - Wei Zhang
- Department of Oto-Rhino-Laryngology, West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre and Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Yu Zhao
- Department of Oto-Rhino-Laryngology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,Department of Oto-Rhino-Laryngology, West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jianjun Ren
- Department of Oto-Rhino-Laryngology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,Department of Oto-Rhino-Laryngology, West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
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4
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Patel V, Tacy CJ, Creamean T, Sibia A, Patel J. Atypical Location of Diffuse Large B-cell Lymphoma in the Nasal Septum. Cureus 2022; 14:e28085. [PMID: 35990567 PMCID: PMC9381438 DOI: 10.7759/cureus.28085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/16/2022] [Indexed: 11/05/2022] Open
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5
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Yun YB, Bae WY, Kim S, Park MG. A Case of Primary Diffuse Large B Cell Lymphoma of the Maxillary Sinus Presenting as Epiphora. JOURNAL OF RHINOLOGY 2022. [DOI: 10.18787/jr.2021.00397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Primary sinusoidal non-Hodgkin’s lymphoma (NHL) is a very rare disease. The main symptoms of sinusoidal NHL are rhinorrhea, nasal obstruction, and post-nasal drip. Symptoms such as eye protrusion, diplopia, trismus, and periorbital pain can also occur. Epiphora is a very rare symptom of sinusoidal NHL, which can lead to a misdiagnosis of dacryocystitis or dacryostenosis. The authors report the case of a 46-year-old female patient who visited hospital for symptoms of epiphora, which did not improve even after 3 months of eye treatment, leading to a final diagnosis of maxillary NHL.
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6
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Multimodality imaging of extra-nodal lymphoma in the head and neck. Clin Radiol 2022; 77:e549-e559. [DOI: 10.1016/j.crad.2022.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/22/2022] [Indexed: 11/19/2022]
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7
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Höglund Wetter M, Mattsson U. Oral manifestations of extranodal lymphomas - a review of the literature with emphasis on clinical implications for the practicing dentist. Acta Odontol Scand 2022; 80:401-410. [PMID: 35108151 DOI: 10.1080/00016357.2021.2020896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Lymphoma is a heterogenous group of malignant tumours with proliferation of lymphoid cells or their precursors. Lymphomas in the head and neck region are usually found in Waldeyer's ring. Intraoral lymphomas are rare and the clinical presentation and roentgenological appearance may resemble other and benign conditions, entailing a risk for diagnostic delay. The objective of the present literature review was to identify subjective symptoms, clinical presentations and roentgenological appearances which should raise suspicion of lymphoma. MATERIALS AND METHODS The literature review identified 41 case series with head and neck lymphomas (n = 3880) and 384 case reports (n = 567 cases) of intraoral lymphomas. Information of demographics, clinical presentation, subjective symptoms and roentgenological appearance was registered. RESULTS The most common clinical presentation was a broad-based swelling or bulging mass with or without simultaneous ulceration, frequently with a relatively rapid growth pattern. Subjective symptoms varied considerably. Intraosseous lymphomas were frequently associated with paresthaesia or numbness. The most common roentgenological finding was a radiolucency with diffuse demarcation. CONCLUSIONS The clinical presentation, symptomatology and roentgenological appearance of intraoral lymphomas varied. Diagnostic delay was usually associated with a lymphoma initially misdiagnosed as a lesion of dental aetiology or a reactive lesion. Inadequate healing after tooth extraction or symptoms of numbness or pain without obvious dental origin should merit further clinical and roentgenological examination. Biopsy is indicated when there is the slightest doubt of the true nature of mucosal lesion.
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Affiliation(s)
| | - Ulf Mattsson
- Clinic of Medical Dentistry, Central Hospital, Karlstad, Sweden
- Department of Oral pathology, Faculty of Odontology, Malmö University, Sweden
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8
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BAKKAL FK, GÜLHAN N, ERAVCI FC, KIZIL Y, AYDİL U. Head and neck lymphomas from otolaryngology perspective. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.948863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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9
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Chaker K, Beghdad M, Mennouni MA, Mkhatri A, Oukessou Y, Mahtar M. Primary laryngeal T-cell lymphoma: A case report and review of the literature. Int J Surg Case Rep 2021; 82:105858. [PMID: 33838485 PMCID: PMC8045033 DOI: 10.1016/j.ijscr.2021.105858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 03/28/2021] [Accepted: 03/28/2021] [Indexed: 12/24/2022] Open
Abstract
Primary lymphoma of the larynx is extremely rare, representing less than 1% of all primary laryngeal neoplasms which consists mainly of non-Hodgkin lymphomas. Diagnosis requires immunohistopathological examination of the laryngeal mass. The clinicopathological characteristics and rational treatment of primary laryngeal lymphoma are still unclear and need to be further defined due to the paucity of this pathology.
Introduction Primary lymphoma of the larynx is extremely rare, representing less than 1% of all primary laryngeal neoplasms. It consists mainly of non-Hodgkin lymphomas (NHLs), represented particularly by diffuse large B-cell. Extranodal natural killer/T-cell lymphoma, presented in larynx is a rare condition that accounts for less than 11% of all lymphomas without distinctive clinicopathologic features, as well as challenging pathologic diagnosis. Case report We report here a case of a 64-years-old man who presented with primary lymphoma type T of the subglottic larynx. A histopathological examination of the biopsy confirmed non-Hodgkin T cell lymphoma. Given his age, he underwent chemotherapy and radiation therapy. The patient was disease-free after 18 months follow up. Conclusion The clinicopathological characteristics and rational treatment of primary laryngeal lymphoma are still unclear and need to be further defined due to the paucity of this pathology.
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Affiliation(s)
- K Chaker
- University Hassan II Casablanca, Morocco
| | - M Beghdad
- University Hassan II Casablanca, Morocco
| | | | - A Mkhatri
- Faculté de Médecine et de Pharmacie de Casablanca, Casablanca, Morocco.
| | - Y Oukessou
- University Hassan II Casablanca, Morocco
| | - M Mahtar
- University Hassan II Casablanca, Morocco
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10
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Mahmood N, Kaya G, Zhang TT, Topple J, Howlett DC. Sonographic appearances of facial lumps in adults with a focus on cheek masses: A pictorial essay. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:175-183. [PMID: 33295669 DOI: 10.1002/jcu.22959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/30/2020] [Accepted: 11/26/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Nadia Mahmood
- Radiology Department, Brighton and Sussex NHS Trust, Brighton, UK
| | - Guven Kaya
- Radiology Department, Brighton and Sussex NHS Trust, Brighton, UK
| | - Ting Ting Zhang
- Radiology Department, Brighton and Sussex NHS Trust, Brighton, UK
| | - Jane Topple
- Radiology Department, East Sussex University Hospitals Trust, Eastbourne, UK
| | - David C Howlett
- Radiology Department, East Sussex University Hospitals Trust, Eastbourne, UK
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11
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Ding C, Huang Y, Shi M, Nie B, Li Y, Wu K, Yang J, Zeng Y. CD20-negative primary middle ear diffuse large B-cell lymphoma coexpressing MYC and BCL-2 secondary to acute lymphoblastic leukemia: A case report. Medicine (Baltimore) 2019; 98:e15204. [PMID: 30985716 PMCID: PMC6485888 DOI: 10.1097/md.0000000000015204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Second diffuse large B-cell lymphoma (DLBCL) after treatment of acute lymphoblastic leukemia (ALL) is uncommon. To our knowledge, primary middle ear DLBCL which presents CD20-negative and coexpression of MYC and BCL-2 has not been reported yet. PATIENT CONCERNS A 20-year-old Chinese man complained fever and weakness for 2 months. Subsequently bone marrow morphology and flow cytometry immunophenotype suggested ALL. Administrated with 9 cycles of multiagent combined chemotherapy, he felt right ear progressive hearing loss, otalgia, aural fullness. Otoendoscopic examination revealed a pitchy mass obstructing the right external auditory canal. Then the mass resection was performed for biopsy and immunohistochemistry examination. DIAGNOSIS The mass was diagnosed as DLBCL which was negative for CD20 and double expression of MYC and BCL-2. INTERVENTIONS Chemotherapy. OUTCOMES The patient eventually gave up and died of severe infection. LESSONS Although intensive chemotherapy has markedly improved the survival of ALL, more and more secondary cancers have been reported. In addition, primary middle ear lymphoma is much rare; hence, it is easy to be misdiagnosed. Furthermore, DLBCL with negative CD20 and double expression of MYC and BCL-2 is aggressive, which is characterized by chemotherapy resistance and inferior survival rates. We discuss this case aiming at raising awareness of tumors secondary to ALL and exploring the appropriate treatment options for the rare DLBCL.
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MESH Headings
- Antigens, CD20/analysis
- Biomarkers, Tumor/analysis
- Diagnosis, Differential
- Ear Neoplasms/chemistry
- Ear Neoplasms/diagnosis
- Ear Neoplasms/drug therapy
- Ear Neoplasms/pathology
- Ear, Middle
- Fatal Outcome
- Humans
- Lymphoma, Large B-Cell, Diffuse/chemistry
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Neoplasms, Second Primary/diagnosis
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology
- Proto-Oncogene Proteins c-bcl-2/analysis
- Proto-Oncogene Proteins c-myc/analysis
- Young Adult
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12
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Darraj E, Hotait H, Abdulghafoor Y, Jabbr M. Hypopharyngeal synovial sarcoma: A case report and literature review. HAMDAN MEDICAL JOURNAL 2019. [DOI: 10.4103/hmj.hmj_63_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Sharma P, Gawande M, Chaudhary M, Ranka R. T-cell lymphoma of oral cavity: A rare entity. J Oral Maxillofac Pathol 2018; 22:104-107. [PMID: 29731565 PMCID: PMC5917515 DOI: 10.4103/jomfp.jomfp_153_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Lymphomas are heterogeneous malignancies of the lymphatic system characterized by lymphoid cell proliferation. They can broadly be divided into Hodgkin's lymphoma (HL) and non-HL (NHL). NHL can originate from B, T or natural killer lymphocytes. Extranodal presentation of T-cell NHL is extremely rare and is often seen in immunocompromised individuals. Here, we report a rare case of T-cell lymphoma of the oral cavity in a 13-year-old patient. The patient was diagnosed to have T-cell lymphoma on the basis of biopsy and immunohistochemistry and was referred to the oral surgery department for definite treatment.
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Affiliation(s)
- Preethi Sharma
- Departments of Oral Pathology and Microbiology, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Madhuri Gawande
- Departments of Oral Pathology and Microbiology, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Minal Chaudhary
- Departments of Oral Pathology and Microbiology, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Rajul Ranka
- Departments of Oral Pathology and Microbiology, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
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14
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Kim SH, Mun SJ, Kim HJ, Kim SL, Kim SD, Cho KS. Differential Diagnosis of Sinonasal Lymphoma and Squamous Cell Carcinoma on CT, MRI, and PET/CT. Otolaryngol Head Neck Surg 2018; 159:494-500. [PMID: 29661053 DOI: 10.1177/0194599818770621] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective The purpose of this study was to analyze computed tomography (CT) and magnetic resonance (MR) images and to evaluate the maximum standardized uptake value (SUV max) of positron emission tomography (PET)/CT parameters between sinonasal non-Hodgkin's lymphoma (NHL) and squamous cell carcinoma (SCC), knowing the imaging features that distinguish sinonasal NHL from SCC. Study Design Case series with chart review. Setting University tertiary care facility. Subjects and Methods We analyzed the features on CT, MR imaging, and PET/CT of 78 patients diagnosed with sinonasal NHL or SCC histopathologically. The CT (n = 34), MRI (n = 25), and PET/CT (n = 33) images of 39 patients with sinonasal NHL and the CT (n = 38), MR (n = 28), and PET/CT (n = 31) images of 39 patients with SCC were evaluated. The sinonasal NHL was diagnosed as natural killer/T-cell lymphoma (n = 28) and diffuse large B-cell lymphoma (n = 11). Results Patients with sinonasal NHL had a larger tumor volume and higher tumor homogeneity than patients with SCC on T2-weighted and postcontrast MR images. Most of the sinonasal NHL and SCC showed a high degree of enhancement. The apparent diffusion coefficient (ADC) values and adjacent bone destruction were significantly lower in sinonasal NHL than in SCC. However, cervical lymphadenopathy, Waldeyer's ring involvement, and PET/CT SUV max showed no significant differences between sinonasal NHL and SCC. Conclusion CT and MR images of sinonasal masses showing a bulky lesion, marked homogeneity, and low ADC values without adjacent bone destruction are more suggestive of sinonasal NHL than SCC.
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Affiliation(s)
- Seok-Hyun Kim
- 1 Department of Otorhinolaryngology and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Sue-Jean Mun
- 1 Department of Otorhinolaryngology and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Hak-Jin Kim
- 2 Department of Radiology, Pusan National University School of Medicine, Pusan National University Hospital, Busan, South Korea
| | - Seon Lin Kim
- 1 Department of Otorhinolaryngology and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Sung-Dong Kim
- 1 Department of Otorhinolaryngology and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Kyu-Sup Cho
- 3 Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan, South Korea
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15
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Hellquist H, Hunt JL, Cardesa A, Skalova A, Slootweg PJ, Rinaldo A, Ferlito A. Role of ancillary techniques in profiling unclassified laryngeal malignancies. Virchows Arch 2018; 472:705-715. [PMID: 29623469 DOI: 10.1007/s00428-018-2348-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/09/2018] [Accepted: 03/26/2018] [Indexed: 12/31/2022]
Abstract
Laryngeal biopsies, contrary to biopsies from many other sites of the body, very often contain minute amounts of tumour tissue that may consist of morphologically undifferentiated tumour only. In haematoxylin- and eosin-stained sections, there may be no indicative features of what specific tumour entity that is present. In the larynx, particularly small round cell neoplasms, primary or metastatic, often cause a diagnostic dilemma and where an incorrect diagnosis can induce substantial clinical consequences for the patient (e.g., primary neuroendocrine carcinomas vs metastatic variants, certain sarcomas). If sufficient/representative material has been obtained, the application of immunohistochemistry and/or molecular techniques should in virtually every case reveal the true nature of the malignancy. In cases with sparse amount of material, and therefore a limited number of sections to be cut, a careful and thoughtful stepwise approach is necessary to ascertain a reliable diagnosis, or at least guide the clinician to the most likely diagnoses. With today's advanced and widely available technology with an abundance of markers to discriminate different tumours, the use of the term "undifferentiated" should be largely unnecessary. In the exceptional, and indeed exceedingly rare cases, when a classification is not possible, even after repeat biopsy, we suggest that the laryngeal neoplasm is better termed "unclassified malignant neoplasm" rather than "undifferentiated malignant neoplasm".
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Affiliation(s)
- H Hellquist
- CBMR, Centre for Biomedical Research, University of Algarve, Edificio 2, Ala Norte, University of Algarve, 8005-139, Faro, Portugal. .,Epigenetics and Human Disease Laboratory, Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal. .,Algarve Biomedical Centre, Campus Gambelas, University of Algarve, Faro, Portugal.
| | - J L Hunt
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - A Cardesa
- Department of Anatomic Pathology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - A Skalova
- Department of Pathology, Faculty of Medicine in Plzen, Charles University, Plzen, Czech Republic
| | - P J Slootweg
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Rinaldo
- University of Udine School of Medicine, Udine, Italy
| | - A Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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Shirazi N, Bist SS, Puri N, Harsh M, Ahmad S. Primary sinonasal lymphoma in immunocompetent patients: A 10 years retrospective clinicopathological study. J Oral Maxillofac Pathol 2018; 22:280-281. [PMID: 30158788 PMCID: PMC6097383 DOI: 10.4103/jomfp.jomfp_45_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Introduction: Sinonasal tumors occur in the nasal cavity or paranasal sinuses (PNS). These tumors are rare and lymphomas are even rarer. Lymphoma of the nose and PNS may mimic benign processes and may manifest either in an isolated fashion or in conjunction with systemic diseases. B-cell lymphomas, a more favorable diagnosis, account for the majority of cases, whereas T-cell and extranodal natural killer lymphoma are associated with rapid disease progression and death. Materials and Methods: All patients with sinonasal lymphomas who were nonreactive for HIV and were operated and treated in our hospital from 2006 to 2016 were included in the study. Histopathological diagnosis and immunohistochemistry using a panel of antibodies (CK, CD99, CD 15, CD30, CD45, Bcl 2, anaplastic lymphoma kinase-1, CD 16, CD 57 and ki-67) were reviewed and recorded. Results: Out of 153 malignant sinonasal tumors, 18 were diagnosed with lymphoma. Non-Hodgkins lymphoma constituted 88.8% of cases with the most common subtype being diffuse large B-cell lymphoma (n = 12, 66.6%). Maxillary sinus was the most frequently involved site (62%). The average age of presentation was 52 years with a slight male predominance. Computed tomography and magnetic resonance imaging scans were done in virtually all cases to assess the extent of the tumor as well as bony destruction. Average 5-year survival was 50%. Local recurrence was the most frequent cause of treatment failure. Conclusion: Malignant lymphomas constituted 11.7% of all malignancies of PNS. The association of diffuse large B-cell tumors with obstructive nasal mass and T-cell tumors with septal perforation, orbital extension and ophthalmological symptoms were more commonly seen.
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Affiliation(s)
- Nadia Shirazi
- Department of Pathology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Sampan Singh Bist
- Department of Ear Nose and Throat, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Neeti Puri
- Department of Pathology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Meena Harsh
- Department of Pathology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Sohaib Ahmad
- Department of General Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
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Steele TO, Buniel MC, Mace JC, El Rassi E, Smith TL. Lymphoma of the nasal cavity and paranasal sinuses: A case series. Am J Rhinol Allergy 2017; 30:335-9. [PMID: 27657899 DOI: 10.2500/ajra.2016.30.4347] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Lymphomas of the sinonasal tract are a rare and heterogeneous subset of solid sinonasal neoplasms. OBJECTIVE To characterize, in this case series, presenting symptoms, treatment modalities, and outcomes for patients with sinonasal lymphoma within a single institution. METHODS Retrospective patient data were collected from an academic, oncologic center and entered into a repository designed to capture outcomes for sinonasal malignancies. Patient demographics, presenting symptoms, imaging findings, treatment modalities, and health status were retrospectively extrapolated and evaluated by using Kaplan-Meier estimations for survival probability. RESULTS Patients with sinonasal lymphoma with a mean follow-up of 50 months were identified (n = 18). Histologic diagnosis included the following: diffuse large B-cell lymphoma (n = 9), natural killer/T-cell lymphoma (n = 5), follicular lymphoma (n = 1), T-cell lymphoma (n = 1), and lymphoma-not otherwise specified (n = 2). The most frequent presenting symptoms were nasal obstruction (78%), facial pain (72%), facial swelling (50%), and nasal discharge (44%). Treatment before lymphoma diagnosis included antibiotics (83%), oral steroids (22%), decongestants (22%), and topical steroids (11%). Treatment regimens after diagnosis included both chemotherapy (94%) and chemoradiotherapy (56%). Survival rates by lymphoma subtype were 56% for B-cell lymphoma and 40% for natural killer/T-cell lymphoma. Overall, 2- and 5-year survival rates were 67% and 50%, respectively. The combination of chemotherapy and radiation resulted in significantly higher survival rates (p ≤ 0.001) than chemotherapy alone. CONCLUSION Sinonasal lymphomas are characterized by meager survival rates, which differ by histopathologic subtype. The diagnosis of sinonasal lymphoma is challenging because symptoms frequently parallel those of chronic rhinosinusitis. Increased awareness of these rare malignancies may improve detection and more timely treatment. Clinical trial registration NCT01332136.
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Affiliation(s)
- Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, USA
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18
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Han AY, Kuan EC, Alonso JE, Badran KW, St John MA. Epidemiology of Nasopharyngeal Lymphoma in the United States: A Population-Based Analysis of 1119 Cases. Otolaryngol Head Neck Surg 2017; 156:870-876. [PMID: 28322119 DOI: 10.1177/0194599817695808] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives To describe the incidence and determinants of survival of patients with nasopharyngeal lymphoma (NPL) between 1973 and 2012 using the Surveillance, Epidemiology, and End Results (SEER) database. Study Design Retrospective cohort study using a national database. Methods The SEER registry was used to calculate survival trends for patients with NPL between 1973 and 2012. Patient data were then analyzed with respect to histopathology, age, sex, race, histologic subtype, Ann Arbor stage, and whether radiation therapy was given. Overall survival (OS) and disease-specific survival (DSS) were calculated. Results A total of 1119 cases of NPL were identified. The cohort was composed of 58.8% males. The mean age at diagnosis was 59.3 years. The median OS was 8.2 years. B-cell non-Hodgkin's lymphomas (NHLs) accounted for most cases (77.5%), with natural killer (NK)/T-cell lymphomas comprising 6.0% of cases. A total of 41.5% patients received radiation therapy. OS at 2, 5, and 10 years was 70%, 57%, and 45%, respectively. On multivariate analysis, advanced age and NK/T-cell NHL histologic subtype were associated with worse OS and DSS, while radiation therapy was associated with improved OS and DSS (all P < .05). Conclusion With the exception of NK/T-cell NHL subtypes, NPL is associated with a fair prognosis, with younger age, low Ann Arbor stage, and radiation therapy being independent positive prognosticators for survival.
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Affiliation(s)
- Albert Y Han
- 1 Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Edward C Kuan
- 1 Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Jose E Alonso
- 1 Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Karam W Badran
- 1 Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Maie A St John
- 1 Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California, USA.,2 Jonsson Comprehensive Cancer Center, UCLA Medical Center, Los Angeles, California, USA.,3 UCLA Head and Neck Cancer Program, UCLA Medical Center, Los Angeles, California, USA
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Primary Burkitt lymphoma of the supraglottic larynx: a case report and review of the literature. J Med Case Rep 2017; 11:65. [PMID: 28279203 PMCID: PMC5345263 DOI: 10.1186/s13256-017-1209-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 01/11/2017] [Indexed: 11/17/2022] Open
Abstract
Background Burkitt lymphoma is a high-grade B cell lymphoma which accounts for less than 1% of all adult cases of non-Hodgkin lymphoma. Rare instances of Burkitt lymphoma developing secondary to prior irradiation have been described in the literature. Case presentation We report a case of a 90-year-old white woman with a recent history of irradiation for Hodgkin lymphoma, who presented with primary Burkitt lymphoma of the supraglottic larynx. She underwent emergency awake tracheostomy with biopsy. A histopathological examination confirmed non-Hodgkin, B cell lymphoma of Burkitt type. Given her age and poor functional status, she underwent treatment with palliative radiotherapy. Conclusions A literature review was performed to clarify the clinical characteristics of radiation-induced Burkitt lymphoma in the head and neck, as well as its diagnosis and management. The present case represents the second case of radiation-induced Burkitt lymphoma in the head and neck in the reported literature, and the first in the supraglottic larynx. It highlights the need to maintain a broad differential in the assessment of malignancies of the larynx, particularly in patients with a prior history of radiation treatment.
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20
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Stelow EB, Wenig BM. Update From The 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Nasopharynx. Head Neck Pathol 2017; 11:16-22. [PMID: 28247232 PMCID: PMC5340728 DOI: 10.1007/s12105-017-0787-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 02/02/2017] [Indexed: 12/30/2022]
Abstract
The current WHO classification system for tumors of the head and neck has made few changes from the previous edition with regards to tumors of the nasopharynx. The classification system is discussed here with particular attention to nasopharyngeal carcinoma, nasopharyngeal papillary adenocarcinoma, salivary gland anlage tumor, hairy polyp, juvenile angiofibroma, and other tumors.
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Affiliation(s)
- Edward B Stelow
- Anatomic Pathology, University of Virginia Health System, Box 800214, Jefferson Park Ave., Charlottesville, VA, 22908, USA.
| | - Bruce M Wenig
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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21
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Al-Rawi NH. Primary non-Hodgkin's lymphoma of the tongue: a diagnostic dilemma of unusual case presentation. BMJ Case Rep 2017; 2017:bcr2016218218. [PMID: 28062438 PMCID: PMC5256451 DOI: 10.1136/bcr-2016-218218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2016] [Indexed: 12/16/2022] Open
Abstract
Primary non-Hodgkin's lymphoma of the tongue is extremely uncommon, which makes its diagnosis quite challenging. A panel of 11 markers is used based on morphological differential diagnosis to elucidate the lymphoma subtype. A case of 43-year-old Egyptian man suffering from nodular mass on the right side of the tongue of 4 months duration is presented. No cervical lymphadenopathy was detected. No abdominal organomegaly was noted. The histological evaluation of incisional biopsy revealed a sheet of pleomorphic lymphoid cells with abnormal mitotic figures. A large number of histiocytes were infiltrating the lymphoid cellular sheet. The results of immunophenotyping were extranodal T-cell lymphoma. A proper immunohistochemical workup is crucial for the correct diagnosis and proper management.
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22
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MRI of diffuse large B-cell non-Hodgkin's lymphoma of the head and neck: comparison of Waldeyer's ring and sinonasal lymphoma. Eur Arch Otorhinolaryngol 2016; 274:1079-1087. [PMID: 27738821 DOI: 10.1007/s00405-016-4337-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 10/04/2016] [Indexed: 12/25/2022]
Abstract
To document the magnetic resonance imaging (MRI) features of diffuse large B-cell lymphoma (DLBCL) in Waldeyer's ring (WR) and the sinonasal (SN) region, and to identify any differences between lymphatic and extra-lymphatic DLBCLs, and predictors of disease beyond the neck. Primary, nodal, and multifocal sites on head and neck MRI were compared between 31 WR and 15 SN DLBCL, and between 27 patients with disease confined to the head and neck and 16 patients with disease beyond the neck, using logistic regression. Compared to SN, WR DLBCLs had significantly smaller primary tumour volumes (p = 0.009), less deep invasion (p = 0.001), and more nodal disease (p = 0.016). Tumour site (WR vs. SN) was an independent predictor of deep invasion (p = 0.007). Nodal and multifocal diseases were predictors of disease beyond the neck (p = 0.027 and 0.011, respectively). Lymphatic WR DLBCLs were less locally aggressive but had greater propensity to nodal spread than extra-lymphatic SN DLBCLs. Nodal and multifocal diseases predicted disease beyond the neck.
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23
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James SLJ, Cozens NJA, Robinson IA. Skeletal Muscle Involvement in Six Cases of Non-Hodgkin's Lymphoma of the Head and Neck Region. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2016. [DOI: 10.1179/174313405x59990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Extra-nodal involvement of non-Hodgkin's lymphoma (NHL) is well described. Skeletal muscle involvement is rare with the muscles of the extremities being most commonly affected. We present a series of six patients that have attended our Joint Head and Neck Ultrasound and Cytopathology clinic. In these cases, skeletal muscle involvement by NHL was demonstrated in the head and neck region. The ultrasound findings in these cases are presented and discussed.
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24
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O'Connor L, Croxson G, McCluskey P, Halmagyi GM. A 43-year-old woman presenting with subacute, bilateral, sequential facial nerve palsies, then developing pseudotumour cerebri. BMJ Case Rep 2015; 2015:bcr-2015-211399. [PMID: 26604227 DOI: 10.1136/bcr-2015-211399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A patient presented elsewhere with what appeared to be a simple, unilateral, chronic suppurative otitis media and then developed an ipsilateral facial palsy. She soon developed the same problem on the other side. At the time, a brain MRI had been ordered but the clinician did not review it with a radiologist. The surgical specimens were not sent for histopathology. When transferred to our institution 3 months later, the patient had severe bilateral papilloedema due to intracranial hypertension due to missed cerebral venous sinus thrombosis. Further surgery revealed that the pathology in the temporal bone was B-cell lymphoma, which, fortunately, responded to chemoradiotherapy. There was good resolution of the facial palsies, but the patient has severe permanent visual loss due to optic atrophy.
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Affiliation(s)
- Laura O'Connor
- Department of ENT, RPA Hospital, Sydney, New South Wales, Australia
| | - Glen Croxson
- Department of ENT, RPA Hospital, Sydney, New South Wales, Australia
| | - Peter McCluskey
- Department of Ophthalmology, RPA Hospital, Sydney, New South Wales, Australia Sydney Medical School, University of Sydney, New South Wales, Australia
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25
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Extranodal lymphoma of the posterior auricle. Am J Otolaryngol 2015; 36:587-9. [PMID: 25913779 DOI: 10.1016/j.amjoto.2015.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 03/31/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Malignant lymphoma of the head and neck represents the most common non-epithelial head and neck cancer. Approximately one third of these occur outside of lymph nodes and have been described in most sub-sites of the head and neck. CASE We describe a case of an elderly woman who presented with a non-healing ulcer on the posterior aspect of her right pinna. Biopsy was performed and found to be a diffuse large B-cell lymphoma. This patient was treated with chemotherapy and local radiation therapy. CONCLUSIONS This is the first reported case of an extranodal lymphoma affecting the auricle. We review lymphoma of the head and neck and the role of the otolaryngologist.
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26
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Thakral B, Zhou J, Medeiros LJ. Extranodal hematopoietic neoplasms and mimics in the head and neck: an update. Hum Pathol 2015; 46:1079-100. [PMID: 26118762 DOI: 10.1016/j.humpath.2015.05.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 05/03/2015] [Accepted: 05/08/2015] [Indexed: 12/30/2022]
Abstract
The head and neck region is a common site for extranodal lymphomas, second only to the gastrointestinal tract; and 12% to 15% of all head and neck tumors are lymphomas. Non-Hodgkin lymphomas are most common, and Hodgkin lymphoma occurs rarely at extranodal sites in the head and neck. Most non-Hodgkin lymphomas of the head and neck region are of B-cell lineage, and the Waldeyer ring is the most common site. Head and neck lymphomas have distinctive epidemiological and clinicopathologic features, including an association with immunosuppression, infectious organisms, or autoimmune disorders; site-specific differences (eg, thyroid gland versus ocular adnexa) for common lymphomas, such as extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue; and genetic differences that provide insights into etiology. Furthermore, the diagnosis of non-Hodgkin lymphomas at extranodal sites implies differences in prognosis and therapeutic implications with lymphomas at nodal sites. In this review, we discuss various types of non-Hodgkin lymphomas and Hodgkin lymphoma, focusing on unique aspects related to the head and neck region. We also discuss a number of newer entities that are clinically indolent as well as mimics of lymphoma that can occur in the head and neck region, including infectious mononucleosis, Kikuchi-Fujimoto disease, Kimura disease, Castleman disease, and immunoglobulin G4-related disease.
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Affiliation(s)
- Beenu Thakral
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
| | - Jane Zhou
- Tufts Medical Center/Tufts University Medical School, 800 Washington Street, Box 802, Boston, MA 02111
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
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Kato H, Kanematsu M, Watanabe H, Kawaguchi S, Mizuta K, Aoki M. Differentiation of extranodal non-Hodgkins lymphoma from squamous cell carcinoma of the maxillary sinus: a multimodality imaging approach. SPRINGERPLUS 2015; 4:228. [PMID: 26120502 PMCID: PMC4478190 DOI: 10.1186/s40064-015-0974-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 04/09/2015] [Indexed: 01/13/2023]
Abstract
This study aimed to assess the efficacy of a multimodality imaging approach for differentiating between primary extranodal non-Hodgkin’s lymphoma (NHL) and squamous cell carcinoma (SCC) of the maxillary sinus. Twelve NHLs and 29 SCCs of the maxillary sinus were included. CT findings, MR signal intensities, apparent diffusion coefficients (ADCs), and maximum standardized uptake values (SUVmax) were correlated with two pathologies. On CT, permeative growth frequency was greater among NHLs than among SCCs (50 % vs. 10 %; p < 0.01), whereas destructive growth frequency was greater among SCCs than among NHLs (83 % vs. 33 %; p < 0.01). On CT, remaining sinus wall within the tumor was more frequent with NHLs than with SCCs (92 % vs. 34 %; p < 0.01), whereas intratumoral necrosis was more frequent with SCCs than with NHLs (86 % vs. 17 %; p < 0.01). ADCs were lower for NHLs than for SCCs (0.61 vs. 0.95 × 10–3 mm2/s; p < 0.01). No significant differences in MR signal intensities and SUVmax were observed. Tumor growth pattern, remaining sinus wall within the tumor, and intratumoral necrosis were useful CT findings for differentiating between NHLs and SCCs. ADC measurements could assist the differentiation of NHL from SCC.
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Affiliation(s)
- Hiroki Kato
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Masayuki Kanematsu
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan ; High-level Imaging Diagnosis Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Haruo Watanabe
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan
| | | | - Keisuke Mizuta
- Department of Otolaryngology, Gifu University School of Medicine, Gifu, Japan
| | - Mitsuhiro Aoki
- Department of Otolaryngology, Gifu University School of Medicine, Gifu, Japan
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Rana K, Narula V, Bhargava EK, Shankar R, Mahajan N. T-cell lymphoma of the oral cavity: case report. J Clin Diagn Res 2015; 9:MD03-4. [PMID: 25954642 DOI: 10.7860/jcdr/2015/11883.5690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 02/02/2015] [Indexed: 11/24/2022]
Abstract
Lymphomas are heterogenous malignancies of the lymphatic system characterized by lymphoid cell proliferation. They can broadly be divided into Hodgkin's lymphoma (HL) and non- Hodgkin's lymphoma (NHL). NHL can originate from B, T, or natural killer (NK) lymphocytes. Extra-nodal presentation of T-cell NHL is extremely rare, and is often seen in immunocompromised individuals. Here, we report a rare case of T-cell lymphoma of the oral cavity in an immune-competent patient. The patient was diagnosed to have T-cell NHL on the basis of biopsy and immunohistochemistry, and was referred to oncology department for chemotherapy for definite treatment.
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Affiliation(s)
- Kanika Rana
- Senior Resident, Department of Ear, Nose and Throat, Maulana Azad Medical College , India
| | - Vineet Narula
- Senior Resident, Department of Ear, Nose and Throat, Maulana Azad Medical College , India
| | - Eishaan K Bhargava
- Junior Resident, Department of Ear, Nose and Throat, Maulana Azad Medical College , India
| | - Ravi Shankar
- Junior Resident, Department of Ear, Nose and Throat, Maulana Azad Medical College , India
| | - Nidhi Mahajan
- Assistant Professor, Department of Pathology, Maulana Azad Medical College , India
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Bagan JV, Carbonell F, Gómez MJ, Sánchez M, Navarro A, Leopoldo M, Bagán L, Zapater E. Extra-nodal B-cell non-Hodgkin's lymphomas of the head and neck: a study of 68 cases. Am J Otolaryngol 2015; 36:57-62. [PMID: 25456517 DOI: 10.1016/j.amjoto.2014.10.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 10/04/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The objectives of this study are to describe the distinctive characteristics of extra-nodal B-cell non-Hodgkin's lymphomas (BNHLs) located in the head and neck in a series of patients, to discuss patient survival, and to compare the oral versus the non-oral locations of the extra-nodal BNHLs of the head and neck. MATERIAL AND METHODS We studied 68 patients with BNHL of the head and neck. We analyzed the clinical and survival characteristics. Additionally, we performed Kaplan-Meier and Cox regression analyses to determine the influence of the different factors on survival. RESULTS This study included 68 non-nodal lymphomas; 30 lymphomas (31.9%) were located intraorally, with the gingiva as the most frequent location. The oral lymphomas in stages 1 and 2 showed a prevalence of 60% (18/30). The Kaplan-Meier analysis showed that the stage of disease and the oral versus non-oral extranodal lymphomas were significant prognostic factors (p<0.05). However, the multivariate Cox analysis indicated that only complete remission and oral versus non-oral location were significant prognostic factors (p<0.01). CONCLUSIONS The gingiva was the most common location of the intraoral lymphomas. Complete remission and non-oral location were the only significant survival factors in the multivariate Cox regression analysis.
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Affiliation(s)
- Jose V Bagan
- Department of Oral Medicine, Valencia University, Valencia, Spain; Department of Oral and Maxillofacial Surgery, University General Hospital, Valencia, Spain.
| | - Felix Carbonell
- Department of Hematology, Valencia University, Valencia, Spain; Department of Hematology, University General Hospital, Valencia, Spain
| | - Maria J Gómez
- ENT Unit, University General Hospital, Valencia, Spain
| | - Magdalena Sánchez
- Department of Hematology, University General Hospital, Valencia, Spain
| | - Atilio Navarro
- Department of Pathology, University General Hospital, Valencia, Spain
| | - Manuel Leopoldo
- Department of Oral and Maxillofacial Surgery, University General Hospital, Valencia, Spain
| | - Leticia Bagán
- Department of Oral Medicine, Valencia University, Valencia, Spain
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Picard A, Cardinne C, Denoux Y, Wagner I, Chabolle F, Bach CA. Extranodal lymphoma of the head and neck: a 67-case series. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 132:71-5. [PMID: 25553969 DOI: 10.1016/j.anorl.2014.07.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 07/02/2014] [Accepted: 07/05/2014] [Indexed: 12/11/2022]
Abstract
UNLABELLED The present study sought to describe clinical presentation in extranodal lymphoma of the head and neck (ELHN), with the aim of improving diagnostic management. MATERIAL AND METHODS A single-center retrospective observational study was conducted over the period 2001-13. Age, gender, histologic type, location, type of clinical presentation, time interval between symptom onset and histologic diagnosis and presence of specific symptoms were recorded, as were the specialty of the physician initially consulted and of the physician taking the diagnostic sample. RESULTS Sixty-seven cases of ELHN were diagnosed: 39 male and 28 female patients, with a median age of 68 years. B-cell lymphoma (84%) was more frequent than plasmacytoma (7%) or T-cell lymphoma (6%). Location was mainly palatine tonsil (28%), nasal fossa and sinus (19%), nasopharynx (14%) or parotid (13%). Revelation often involved a mass (33%), and only rarely any specific symptoms (9%). Time interval from symptom onset to diagnosis was short in aggressive lymphoma and longer in low-grade lymphoma (mean 4 and 10 months respectively). The physician initially consulted was an ENT specialist in 67% of cases, and an ENT specialist performed diagnostic sampling in 97% of cases. CONCLUSION ELHN is a rare pathology (5 cases per year in our department) of highly variable clinical presentation depending on location and histologic type. The ENT physician should be prepared for diagnosis regardless of anatomic location, so as to optimize diagnostic management.
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Affiliation(s)
- A Picard
- Service de chirurgie ORL et cervico-faciale, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - C Cardinne
- Service de chirurgie ORL et cervico-faciale, hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Université de Versailles Saint-Quentin-en-Yvelines, UFR de médecine Paris Ouest Saint-Quentin-en-Yvelines, 78280 Guyancourt, France
| | - Y Denoux
- Service d'anatomo-pathologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - I Wagner
- Service de chirurgie ORL et cervico-faciale, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - F Chabolle
- Service de chirurgie ORL et cervico-faciale, hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Université de Versailles Saint-Quentin-en-Yvelines, UFR de médecine Paris Ouest Saint-Quentin-en-Yvelines, 78280 Guyancourt, France
| | - C A Bach
- Service de chirurgie ORL et cervico-faciale, hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Université de Versailles Saint-Quentin-en-Yvelines, UFR de médecine Paris Ouest Saint-Quentin-en-Yvelines, 78280 Guyancourt, France.
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Farquhar D, Sobanko J, Williams K, Newman JG. A vanishing lymphoma in the cheek. ORL J Otorhinolaryngol Relat Spec 2014; 76:189-92. [PMID: 25138135 DOI: 10.1159/000365853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND We describe the unusual case of a 66-year-old woman who presented with a cheek mass that completely abated with oral steroids. CASE REPORT Multiple separate biopsies of the mass were negative or inconclusive. MRI revealed a large mass, yet after a short steroid course, this mass was completely undetectable on clinical examination. A repeat biopsy eventually revealed follicular lymphoma. DISCUSSION Lymphomas are known to be steroid sensitive; the medication is an essential component of the common CHOP therapy. While known to occur in the central nervous system, to the best of our knowledge, the presence of a 'vanishing' lymphoma has not been documented in the head and neck. We discuss the likely physiology of the vanishing lymphoma, and the diagnostic difficulty it presents. CONCLUSION When a lymphoma is suspected, patient care may be optimized if biopsy is delayed until steroids have been discontinued.
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Affiliation(s)
- Douglas Farquhar
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pa., USA
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Nayak PB, Desai D, Pandit S, Rai N. Centroblastic variant of diffuse large B-cell lymphoma: Case report and review of literature. J Oral Maxillofac Pathol 2013; 17:261-5. [PMID: 24250090 PMCID: PMC3830238 DOI: 10.4103/0973-029x.119749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is a subtype of non-Hodgkin's lymphoma (NHL) making up about approximately 30% of all NHL. Its occurrence in the mandible is very rare. Histopathologically, five variants of DLBCL have been recognized among which centroblastic variant is the one with better prognosis. We report a case of a 55 year-old patient who presented with a painless swelling in the lower right body of the mandible since 4 months. Incisional biopsy revealed NHL like features, confirmed by immunohistochemistry using CD45, CD20, and CD3 markers to be a DLBCL of centroblastic variant. Patient was treated with chemotherapy following which the lesion regressed completely with no further recurrences. Precise histological diagnosis is crucial for the clinical management and ultimately for the survival of the patient.
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Affiliation(s)
- Preethi B Nayak
- Department of Oral Pathology and Microbiology, A. J. Institute of Dental Sciences, Kuntikana, Mangalore, Karnataka, India
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Salivary gland lymphoproliferative disorders: a Canadian tertiary center experience. Head Neck Pathol 2013; 7:381-8. [PMID: 23821219 PMCID: PMC3824808 DOI: 10.1007/s12105-013-0468-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 06/21/2013] [Indexed: 10/26/2022]
Abstract
Salivary gland lymphoproliferative disorders (SGLD) are very rare tumors and clinicopathological data is sparse. In a Canadian series of 30 cases, extracted from the surgical pathology files of The Ottawa Hospital between 1990 and 2010, a clinical, histopathological, and immunophenotypic analysis was conducted. Tumors were staged using the Ann Arbor staging and classified using the World Health Organization 2008 classification. There were 15 salivary gland (SG) primary lymphomas with localized disease, predominantly mucosa associated lymphoid tissue type marginal zone lymphoma (MALT-L), but with a significant incidence of low grade follicular lymphoma (FL) and diffuse large B cell phenotype as well. There were 7 systemic SG lymphomas and 5 patients were diagnosed with lymphoproliferative disorders originating from intra-parotid lymph nodes. Finally, the remaining 3 cases represented reactive sialadenitis. A literature review was conducted and our primary lymphoma group was compared to those from other countries. SGLDs are predominantly B cell lymphomas that develop in older adults. Primary tumors, which have MALT-L and low grade FL characteristics, have a favorable survival, however MALT-L have a high rate of relapse. A minority of SG lesions are excised secondary to lymphomas that definitely arose from intra-parotid lymph nodes.
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Kato H, Kanematsu M, Kawaguchi S, Watanabe H, Mizuta K, Aoki M. Evaluation of imaging findings differentiating extranodal non-Hodgkin's lymphoma from squamous cell carcinoma in naso- and oropharynx. Clin Imaging 2013; 37:657-63. [DOI: 10.1016/j.clinimag.2012.11.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Revised: 10/21/2012] [Accepted: 11/20/2012] [Indexed: 02/07/2023]
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Characteristics and prognostic factors for head and neck non-Hodgkin's lymphoma in Chinese patients. The Journal of Laryngology & Otology 2013; 127:699-704. [PMID: 23738972 DOI: 10.1017/s0022215113001217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND OBJECTIVES The head and neck region is the second most frequent anatomical site of extranodal lymphomas. These tumours affect many individuals worldwide, justifying epidemiological studies in different countries. This study evaluated the characteristics, treatments and prognostic factors for non-Hodgkin's lymphoma of the head and neck in Chinese patients. METHOD The clinical manifestations, clinicopathological characteristics, multidisciplinary treatment and prognostic factors for 102 patients with extranodal non-Hodgkin's lymphoma of the head and neck were analysed retrospectively. RESULT The tonsil was the most commonly involved primary site, followed by the nasal cavity. The most common histological subtype was diffuse large B-cell lymphoma, followed by natural killer T-cell lymphoma. Patients receiving a combination of rituximab and chemotherapy did better than those receiving chemotherapy alone. Prognosis was significantly associated with both International Prognostic Index and histological subtype; the former was especially strongly associated with poor survival. CONCLUSION In this group of Chinese patients, diffuse large B-cell lymphoma was the most common pathological subtype, but the incidence of T-cell lymphomas was higher than that reported in the USA. Combined rituximab and chemotherapy led to better outcomes than chemotherapy alone. Prognosis depended on both International Prognostic Index and histological subtype.
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Iguchi H, Wada T, Matsushita N, Oishi M, Yamane H. Anatomic distribution of hematolymphoid malignancies in the head and neck: 7 years of experience with 122 patients in a single institution. Acta Otolaryngol 2012; 132:1224-31. [PMID: 23025415 DOI: 10.3109/00016489.2012.694474] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
CONCLUSION Most hematolymphoid malignancies in the head and neck were malignant lymphomas that most often occurred in sexagenarian men. Approximately 80% of them were B-cell lymphomas with a predominance of diffuse large B-cell lymphoma (DLBCL) in both nodal and extranodal sites. Our results were compatible with those in a previous study that was conducted in the central part of Japan. OBJECTIVES This analysis was performed to describe the anatomic distribution of hematolymphoid malignancies that were diagnosed by biopsy in our department. METHODS Clinical medical records of 122 patients with hematolymphoid malignancies in the head and neck from January 2004 to December 2010 were retrospectively reviewed. The anatomic site of origin according to the histopathology of each malignancy was analyzed. RESULTS The incidence ratio of hematolymphoid malignancies was 15.1%. The male:female ratio was 2.3:1. Ages ranged from 17 to 89 years (median, 66). Of the 122 cases, 121 were lymphoid neoplasms (4 cases of Hodgkin lymphoma and 117 cases of non-Hodgkin lymphoma) and the remaining 1 was myeloid. The most common histopathology was DLBCL (54.9%), followed by follicular lymphoma (8.2%), and peripheral T-cell lymphoma (8.2%). Most commonly, the oropharynx (36.1%) and the cervical lymph node (34.4%) were affected.
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Affiliation(s)
- Hiroyoshi Iguchi
- Department of Otolaryngology and Head & Neck Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
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Madana J, Yolmo D, Saxena SK, Gopalakrishnan S. Primary extranodal T-cell non-Hodgkin lymphoma of the tongue. EAR, NOSE & THROAT JOURNAL 2012; 91:E1-3. [PMID: 22278870 DOI: 10.1177/014556131209100113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The most common sites of extranodal non-Hodgkin lymphoma (NHL) are the gastrointestinal tract and the head and neck region. Head and neck involvement accounts for 8 to 13% of all extranodal lymphomas. Primary NHLs of the oral cavity, especially in the tongue, are extremely rare, which makes it difficult to understand their biologic behavior. Extranodal NHLs of the tongue usually present as a nodular lesion of the B-cell type. The T-cell variant of tongue NHL with an ulcerated exophytic presentation is extremely rare. We report such a case in a 37-year-old woman.
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Affiliation(s)
- J Madana
- Department of Otorhinolaryngology-Head and Neck Surgery, National University Health System, 1E Kent Ridge Rd., Republic of Singapore 119228.
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Mantle cell lymphoma of the oral cavity with multiple foci: a case report and review of the literature. J Maxillofac Oral Surg 2012; 14:138-44. [PMID: 25838687 DOI: 10.1007/s12663-012-0383-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Accepted: 04/04/2012] [Indexed: 12/18/2022] Open
Abstract
Non-Hodgkin lymphomas (NHLs) are often present outside the lymph nodes. Although primary extranodal NHLs form a substantial part of all NHLs, reports on oral primary extra nodal NHLs are rare. Mantle cell lymphoma (MCL) is a rare B-cell neoplasm that has only recently been defined as a distinct entity. MCL of the oral cavity is an uncommon diagnosis. Most oral MCLs occur in an elderly male population and have a possible predilection for the palate. The microscopic diagnosis can be challenging, given its similar appearance to other small cell lymphomas, requiring a comprehensive immunohistochemical panel for the accurate diagnosis. Like MCL occurring in other sites in the body, the prognosis and outcome of oral MCL appears to be poor.
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Chi HS, Lee KW, Chiang FY, Tai CF, Wang LF, Yang SF, Lin SF, Kuo WR. Head and neck extranodal lymphoma in a single institute: a 17-year retrospective analysis. Kaohsiung J Med Sci 2012; 28:435-41. [PMID: 22892165 DOI: 10.1016/j.kjms.2012.02.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 09/01/2011] [Indexed: 11/26/2022] Open
Abstract
The study's purposes are to identify patient characteristics, treatment response and survival rate, and to describe the important prognostic factors for our patients with extranodal head and neck lymphoma. Furthermore, no study has systemically discussed the overall figure of this disease in Taiwan and we analyzed our data on this topic. A retrospective review was performed for 86 patients with extranodal head and neck lymphoma, diagnosed in Kaohsiung Medical University Hospital, between 1990 and 2007. We evaluated the medical records and analyzed the possible factors affecting treatment outcomes, survival rate, and free-from-disease (FFD) survival rate. Forty-nine male and 37 female patients were included with a male:female ratio of 1.32:1. The most frequent histologic type was diffuse large B cell lymphoma, accounting for 41.9% of the total. The most common primary site involved with extranodal head and neck non-Hodgkin's lymphoma was a tonsil with 27 cases (31.4%). Stage, international prognostic index (IPI) score, B symptoms, lactate dehydrogenase (LDH) level, and lymph node status significantly affected treatment response. The overall 5- and 10-year survival rates were 68.0% and 57.8%, respectively. The FFD survival rate was 53.6% and 49.3% at 5 and 10 years, respectively. Factors including stage, lymph node status, LDH level, and IPI score produced significant differences in both overall survival and FFD survival. Our analyzed information is similar to other previously presented studies. Stage, IPI score, B symptoms, LDH level, and neck nodal status can be used to evaluate the treatment outcomes. Neck nodal status and stage are the two significant prognostic factors for overall survival.
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Affiliation(s)
- Hung-Sheng Chi
- Department of Otolaryngology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
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Cho KS, Kang DW, Kim HJ, Lee JK, Roh HJ. Differential Diagnosis of Primary Nasopharyngeal Lymphoma and Nasopharyngeal Carcinoma Focusing on CT, MRI, and PET/CT. Otolaryngol Head Neck Surg 2012; 146:574-8. [DOI: 10.1177/0194599811434712] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective. No study has done a comparative analysis of radiologic imaging findings between primary nasopharyngeal lymphoma (PNL) and nasopharyngeal carcinoma (NPC). The purpose of this study was to analyze computed tomography (CT) and magnetic resonance (MR) images and to evaluate the maximum standardized uptake value (SUV max) of positron emission tomography (PET)/CT between PNL and NPC, knowing the imaging features that distinguish PNL from NPC. Study Design. Cross-sectional study. Setting. University tertiary care facility. Subjects and Methods. The authors analyzed the features on CT, MR imaging, and PET/CT of 16 patients diagnosed with PNL and 32 patients diagnosed with NPC histopathologically. Results. Patients with PNL had a larger tumor volume and showed symmetry of tumor shape than did patients with NPC. Patients with PNL also had higher tumor homogeneity than NPC patients on CT, T2-weighted, and postcontrast MR images. All PNL patients showed a high degree of enhancement without invasion to the adjacent deep structure. The involvement of the Waldeyer ring was significantly higher in PNL patients. Cervical and retropharyngeal lymphadenopathy and PET/CT SUV max showed no significant difference between PNL and NPC. Conclusions. If the images present a bulky, symmetric nasopharyngeal mass with marked homogeneity, a high degree of enhancement, and a higher Waldeyer ring involvement combined with no invasion into the deep structure, PNL should be considered over NPC.
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Affiliation(s)
- Kyu-Sup Cho
- Department of Otorhinolaryngology and Medical Research Institute, Pusan National University School of Medicine, Busan, South Korea
| | - Dae-Woon Kang
- Department of Otorhinolaryngology and Medical Research Institute, Pusan National University School of Medicine, Busan, South Korea
| | - Hak-Jin Kim
- Department of Radiology, Pusan National University School of Medicine, Busan, South Korea
| | - Jong-Kil Lee
- Department of Otorhinolaryngology and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Hwan-Jung Roh
- Department of Otorhinolaryngology and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
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Shah GH, Panwar SK, Chaturvedi PP, Kane SN. Isolated primary extranodal lymphoma of the oral cavity: A series of 15 cases and review of literature from a tertiary care cancer centre in India. Indian J Med Paediatr Oncol 2011; 32:76-81. [PMID: 22174494 PMCID: PMC3237184 DOI: 10.4103/0971-5851.89776] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Non-Hodgkin's lymphomas (NHL) have a great tendency to affect organs and tissues that do not ordinarily contain lymphoid cells. Involvement of the oral cavity by NHL is very rare. MATERIALS AND METHODS Retrospective analysis was carried out by chart review of patients who presented to our hospital between 1990 and 2008. All those patients whose histopathology at our hospital was confirmed as lymphoma were included. RESULTS Although we register nearly 2000 new oral cancers every year, most of which are squamous cell cancers, we could trace only 15 cases of oral lymphoma in the last 18 years. Of these, hard palate and alveolus were most common sites (5 each). The median age at presentation was 42.6 years. A vast majority (12/15) were NHL. Most patients (70%) reported with painless progressive swelling without systemic signs, such as fever, weight loss, and so on. Only 2 patients were HIV positive. Nearly two thirds received combinations of CT and RT. Cyclophosphamide, hydroxydaunorubicin, oncovin (vincristine), prednisolone regime was the most common regime offered (12/15). Most of them (67%) had good response to 6 cycles of CT that was followed by RT. 10/15 patients completed treatment. Follow-up data of more than 2 years of follow-up was present in 11/15 patients. With median follow-up of 27 months, 5 were disease free, 5 died, and 1 controlled following 2nd line of CT, 2 were lost to follow-up and 2 were alive with disease. DISCUSSION Head and neck lymphoma is the second most common region for extranodal lymphoma. The nasopharynx, tonsils, and base tongue are most often involved. Unlike the western world, oral cavity involvement is extremely rare. Interestingly, only 2 patients tested positive for HIV and most were young patients. Oral lymphoma may mimic benign oral conditions that often lead to misdiagnosis. CONCLUSION Although oral cavity may be the preferred site of NHL in immunocompromised patients it does occur in immunocompetent patients as well. Isolated oral lymphoma is extremely rare and from our data we can say that oral NHL in Indian sub population is more aggressive compared with western literature.
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Affiliation(s)
- Gunjan H. Shah
- Departments of Head & Neck Oncology and Pathology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Sajid Khan Panwar
- Departments of Head & Neck Oncology and Pathology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Pankaj P. Chaturvedi
- Departments of Head & Neck Oncology and Pathology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Shubhada N. Kane
- Departments of Head & Neck Oncology and Pathology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
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Minca EC, Popat SR, Chadha MK, Merzianu M. Small lymphocytic lymphoma obscuring microscopic tonsillar squamous cell carcinoma: an unknown occurrence with a known primary. Head Neck Pathol 2010; 6:125-9. [PMID: 21120710 PMCID: PMC3311942 DOI: 10.1007/s12105-010-0228-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 11/11/2010] [Indexed: 10/18/2022]
Abstract
Head and neck squamous cell carcinoma (HNSCC) often presents with cervical lymph node metastases and at times the primary tumor cannot be identified despite extensive workup. Lymphoma is the second most common neoplasm in the head and neck region but is seldom synchronous with HNSCC and rarely involves regional mucosal sites. We report herein a rare occurrence of tonsillar involvement by small lymphocytic lymphoma (SLL) incidentally detected during the workup for a cervical lymph node SCC metastasis of a 52-year-old non-smoker male. The microscopic human papillomavirus-positive SCC involving the tonsillar surface and crypts was obscured by SLL leading to the initial designation of 'unknown primary'. The occult HNSCC are likely explained by small tumor size, quality and quantity of sampling, thoroughness of endoscopic, radiological and pathological assessment or a combination of the above. The coexistence of another tumor such as lymphoma has not yet been reported as a confounding factor in the workup for cervical SCC metastasis. Since oropharyngeal SCC can be very small and Waldeyer's ring is a common site for lymphoma involvement, identification of such rare collision tumors requires pathologists' awareness, extensive sampling and occasionally ancillary studies for the accurate diagnosis and staging essential for the correct management.
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Affiliation(s)
- Eugen C. Minca
- Department of Pathology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263 USA
| | - Saurin R. Popat
- Department of Otolaryngology—Head and Neck Surgery, School of Medicine, State University of New York at Buffalo, Buffalo, NY 14214 USA
| | | | - Mihai Merzianu
- Department of Pathology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263 USA
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Hui D, Proctor B, Donaldson J, Shenkier T, Hoskins P, Klasa R, Savage K, Chhanabhai M, Gascoyne RD, Connors JM, Sehn LH. Prognostic implications of extranodal involvement in patients with diffuse large B-cell lymphoma treated with rituximab and cyclophosphamide, doxorubicin, vincristine, and prednisone. Leuk Lymphoma 2010; 51:1658-67. [DOI: 10.3109/10428194.2010.504872] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Etemad-Moghadam S, Tirgary F, Keshavarz S, Alaeddini M. Head and neck non-Hodgkin's lymphoma: a 20-year demographic study of 381 cases. Int J Oral Maxillofac Surg 2010; 39:869-72. [PMID: 20538427 DOI: 10.1016/j.ijom.2010.03.029] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2009] [Revised: 12/14/2009] [Accepted: 03/16/2010] [Indexed: 12/21/2022]
Abstract
Malignant lymphoma is a lymphoreticular malignancy with considerable geographic variation. The objective of the present study was to provide a preliminary report on patients with head and neck non-Hodgkin's lymphoma (NHL) in a selected Iranian population. In a retrospective review from 1981 through 2001, all cases of NHL occurring in the head and neck region were selected. Histological slides were reviewed and classified according to the Working Formulation. Clinical data including patients' age, sex, initial anatomic site of disease and presenting symptoms were also recorded. Information on 381 cases of NHL was retrieved from the archived medical records; 281 cases were nodal and 100 extranodal. The mean age of the patients with nodal and extranodal disease was 39.3 and 47.7 years, respectively. A significant difference in gender was noted in the nodal group (P<0.001), but not in the extranodal cases. The most common site of involvement in the extranodal subjects was Waldayer's ring. According to histopathologic evaluation, 72% of the specimens were intermediate-, 14% were high-, and 12% were low-grade malignancies. Considering the relative frequency of head and neck lymphoma, establishment of a uniform reporting method seems necessary in order to compare different reports from various populations.
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Gaini RM, Romagnoli M, Sala A, Garavello W. Lymphomas of head and neck in pediatric patients. Int J Pediatr Otorhinolaryngol 2009; 73 Suppl 1:S65-70. [PMID: 20114159 DOI: 10.1016/s0165-5876(09)70013-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cancer among children is relatively uncommon, with approximately 1 in 7,000 children 0 to 14 years of age being newly diagnosed each year in the United States, and Hodgkin and non-Hodgkin's lymphomas constitute 10-15% of all childhood cancers in the more developed countries, after acute leukemias and brain tumors. The diagnosis of lymphoma frequently involves otolaryngologists that play also an important role in the its management. A high index of suspicion for lymphoma as a cause of complaints in the head and neck region can lead an early diagnosis and improved outcome for lymphomas. This article reviews the epidemiology, presentation, diagnosis, staging, treatment and prognosis of Hodgkin and non-Hodgkin's lymphomas in children.
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Affiliation(s)
- Renato Maria Gaini
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Milano-Bicocca, DNTB, Monza, Italy
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Imai T, Michizawa M, Degami H. NK cell lymphoblastic lymphoma in the masticator space: a case of non-Hodgkin lymphoma with challenging maxillofacial manifestation and immunophenotype. ACTA ACUST UNITED AC 2009; 108:897-903. [DOI: 10.1016/j.tripleo.2009.07.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Revised: 07/06/2009] [Accepted: 07/18/2009] [Indexed: 10/20/2022]
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Thakur JS, Minhas RS, Mohindroo NK, Sharma DR, Mohindroo S, Thakur A. Primary non-Hodgkin's lymphoma of the infratemporal fossa: a rare case report. HEAD & NECK ONCOLOGY 2009; 1:20. [PMID: 19545392 PMCID: PMC2711953 DOI: 10.1186/1758-3284-1-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Accepted: 06/21/2009] [Indexed: 11/10/2022]
Abstract
BACKGROUND The head and neck are two of the most common sites of extranodal non-Hodgkin's lymphoma (NHL). However, primary tumors of the infratemporal fossa are infrequent, and NHL in this region is extremely rare. CASE PRESENTATION We present a case of a 41-year-old female that presented with swelling in the right preauricular region that had persisted for the past two years. The patient was diagnosed as having a small lymphocytic NHL. She initially underwent chemo-radiation but reported relapse. The tumor was excised and again the patient underwent chemotherapy. The patient remained symptomatic and developed a second primary squamous cell carcinoma in the right retromolar trigone. DISCUSSION AND CONCLUSION We discussed NHL with an emphasis on extranodal manifestations. Extranodal NHL that is limited to a single site can be managed by surgery and regular follow up. To the best of our knowledge, this is only the second case of primary NHL of the infratemporal fossa to be reported in the literature.
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Affiliation(s)
- Jagdeep S Thakur
- Department of Otolaryngology-Head & Neck Surgery, I. G. Medical College, Shimla, HP, 171001, India.
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Essadi I, Ismaili N, Tazi E, Elmajjaoui S, Saidi A, Ichou M, Errihani H. Primary lymphoma of the head and neck: two case reports and review of the literature. CASES JOURNAL 2008; 1:426. [PMID: 19116013 PMCID: PMC2639388 DOI: 10.1186/1757-1626-1-426] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Accepted: 12/30/2008] [Indexed: 11/16/2022]
Abstract
Background The head and neck is the second most common region for the extra-nodal lymphomas after that of gastrointestinal tract. Approximately 2.5% of malignant lymphoma arises in the oral and para-oral region. In this paper we report two cases of early stage head and neck lymphoma which were managed successfully with chemotherapy and a review of the related literature. Cases presentation The first case concerns a 48 years male patient having a diffuse large B-Cell lymphoma of the oropharynx at early bulky stage. This patient was managed successfully with 7 of Rituximab 375 mg/m2, Cyclophosphamide 750 mg/m2 d1, Doxorubicine 50 mg/m2 d1, Vincristine 1.4 mg/m2 d1, and prednisone 50 mg/m2 d1-5 (RCHOP) regimen. The second case concerns a 50 years female patient having the nasal natural killer (NK)/T-cell lymphoma of the left nasal pit at early stage. This case was managed successfully with 6 of Cyclophosphamide 750 mg/m2 d1, Doxorubicine 50 mg/m2 d1, Vincristine 1.4 mg/m2 d1, and prednisone 50 mg/m2 d1-5 (CHOP) regimen. Conclusion These two cases highlight the important role of CHOP based chemotherapy for achieving successful treatment cure for patients having an early stage head and neck lymphoma.
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Affiliation(s)
- Ismail Essadi
- Department of Medical Oncology, Mohamed V Military Hospital, Rabat, Morocco
| | - Nabil Ismaili
- Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco
| | - Elmehdi Tazi
- Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco
| | - Sanaa Elmajjaoui
- Department of Radiotherapy, National Institute of Oncology, Rabat, Morocco
| | | | - Mohammed Ichou
- Department of Medical Oncology, Mohamed V Military Hospital, Rabat, Morocco
| | - Hassan Errihani
- Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco
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Wong KK, Prepageran N, Peh SC. Prognostic subgroup distribution in diffuse large B-cell lymphoma of the upper aerodigestive tract. Pathology 2008; 41:133-9. [PMID: 18972319 DOI: 10.1080/00313020802436790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIMS To stratify upper aerodigestive tract (UAT) diffuse large B-cell lymphoma (DLBCL) into prognostic subgroups by immunohistochemical staining (IHC) method, and to evaluate the association rate of UAT DLBCL with Epstein-Barr virus (EBV). METHODS Using a panel of antibodies to CD10, Bcl-6, MUM1 and CD138, consecutive cases of primary UAT DLBCL were stratified into subgroups of germinal centre B-cell-like (GCB) and non-GCB, phenotype profile patterns A, B and C, as proposed by Hans et al. and Chang et al., respectively. EBER in situ hybridisation technique was applied for the detection of EBV in the tumours. RESULTS In this series of 32 cases of UAT DLBCL, 34% (11/32) were GCB, and 66% (21/32) were non-GCB types; 59% (19/32) had combined patterns A and B, and 41% (13/32) had pattern C. Statistical analysis revealed no significant difference in the occurrence of these prognostic subgroups in the UAT when compared with series of de novo DLBCL from all sites. There was also no site difference in phenotype protein expressions, with the exception of MUM1. EBER in situ hybridisation stain demonstrated only one EBV infected case. CONCLUSIONS Prognostic subgroup distribution of UAT DLBCL is similar to de novo DLBCL from all sites, and EBV association is very infrequent.
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Affiliation(s)
- Kah-Keng Wong
- Department of Pathology, Faculty of Medicine, University of Malaya, University Malaya Medical Centre, Kuala Lumpur, Malaysia
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Nagasaki A, Miyagi T, Taira T, Shinhama A, Kojya S, Suzuki M, Aonahata M, Yoshimi N, Takasu N. Adult T-cell leukemia/lymphoma with multiple integration of HTLV-1 provirus presenting as an isolated paranasal sinus tumor: A case report. Head Neck 2008; 30:815-20. [DOI: 10.1002/hed.20730] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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