Generally, MCL patients have a median age of 60years and a striking male predominance [42] .Three of the four cases of MCL including our case, occurred at the base of the tongue. Oral and Maxillofacial Pathology. Non-Hodgkin's lymphoma of the head and neck: a 30-year experience at the University of Florida. Curr Top Microbiol Immunol. Review of the preoperative anaesthesia records revealed no features of airway obstruction nor B symptoms on clinical history. This is consistent with head and neck research findings [6, 26]. 2, pp. FOIA This entity was first described in 1973 by Adkins. Work-up of globus: assessing the benefits of neck ultrasound and videofluorography. We not only report on the general clinicopathological features, including age, gender, tumour location, histological subtypes, grading and staging, but also provide important information related to prognosis and treatment. 2017;18:27815. Epub 2009 Jun 26. Cut-off values were set as previously described [9]. government site. 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HHS Vulnerability Disclosure, Help Improved survival of patients with human papillomavirus-positive head and neck squamous cell carcinoma in a prospective clinical trial. Our HPV-infected patient indeed had a favourable prognosis, and he was alive and free of disease when this manuscript was prepared (68months). https://doi.org/10.1053/ajot.2000.8382. Spectrum of a benign entity. Our attention is especially drawn to areas where increased gingival growth is uncommon, such as the soft palate, uvula, and posterior oropharynx. The therapeutic response is related to the pathological subtype and several factors, such as old age, high grade histology, bulky lymph nodes, higher IPI score, and advanced stage [22, 24, 25]. [27], which comprised 9 cases of GC and 4 cases of NGC. Large B-cell lymphoma of the base of the tongue and oral cavity: a practical approach to identifying prognostically important subtypes. Cutaneous lymphoid hyperplasia is generally not malignant, but in rare cases an association has been observed. None of the seven patients presented systemic symptoms (body weight loss, fever and night sweating). The follicles are cytologically polymorphous, are often polarized, and vary in size and shape. Similarly, the inner cortex has T cells and is called the T-cell zone. The pathological diagnosis was MCL. Pathology may also show indistinct germinal centres leading to erroneous diagnosis of follicular lymphoma [3]. In the middle power view, there were plenty of moderate to large cells with distorted nuclear contours (Fig. The patient was decannulated and discharged home 14 days after tracheotomy. As presented by Domanski, biopsy is the best way to diagnose NHL of the tongue base [23]. Metastasis of the regional neck lymph nodes was noted in one case at the time of diagnoses. When on the surface tissue, there may be a yellow, white, or even vesicular appearance, as seen in Figure 1. In addition, patients may notice irregularities on their own, thereby bringing the appearance to the attention of their dentists or hygienists. Six of the cases exhibited tongue base masses with smooth surface membranes. Provided by the Springer Nature SharedIt content-sharing initiative. The study utilized immunochemistry, in situ hybridization (ISH), and gene rearrangement to confirm the disease and and performed a clinical follow up for each case. Lopez-Guillermo A, Colomo L, Jimenez M, Bosch F, Villamor N, Arenillas L, Muntanola A, Montoto S, Gine E, Colomer D, Bea S, Campo E, Montserrat E. Diffuse large B-cell lymphoma: clinical and biological characterization and outcome according to the nodal or extranodal primary origin. When the lymphoid tissue is deeply seated, the appearance may be more pink or deeper in color. 3840, 1973. Must be distinguished from monomorphous T cell lymphoma. Imaging and pathological findings of PTCL (case 3). 2006;45:25871. This study describes the clinicopathological features of NHL in the tongue base and the status of HPV and EBV in these cases. https://doi.org/10.1200/JCO.2005.07.155. K. F. Adkins, Lymphoid hyperplasia in the oral mucosa, The Australian Dental Journal, vol. Lymphoid hyperplasia is the rapid proliferation of normal lymphocytic cells that resemble lymph tissue which may occur with bacterial or viral infections. Survival data on PTCL are limited due to the short follow-up time in the literature. Before Mod Pathol. In the study of Eisuke et al., hypermethylation of the p16 promotor indicated a poor prognosis [35]. Please enable it to take advantage of the complete set of features! MeSH M. Samoszuk, E. Ramzi, and J. Ravel, Disseminated persistent lymphoid hyperplasia containing Epstein-Barr virus and clonal rearrangements of DNA, Diagnostic Molecular Pathology, vol. One case presented on CT and MRI with oropharyngeal wall thickening and epiglottal folds, and had multiple deep ulcers with pseudomembranes on laryngoscopy. Reported cases involve the conjunctiva, liver, gastrointestinal tract, stomach, lungs, paranasal sinuses, and many cutaneous areas. Call your doctor or 911 if you think you may have a medical emergency. M Gromet, M J Homer, B L Carter Published Online: Sep 1 1982 https://doi.org/10.1148/radiology.144.4.7111732 PDF Share Article History Published in print: 1982 Figures References Related Details Vol. Ekstrom-Smedby K. Epidemiology and etiology of non-Hodgkin lymphoma--a review. Unable to load your collection due to an error, Unable to load your delegates due to an error. In the orofacial region, RLH most often occurs in the oropharynx, Waldeyers tonsillar ring, the soft palate, the lateral tongue, and the floor of the mouth.2 Waldeyers ring includes the lingual and palatine tonsils, the adenoids, lymphoid follicles located on the posterolateral tongue in the area of the foliate papillae, and level 1 lymph nodes in the floor of the mouth. J Clin Oncol. Xinyu Ren and Yin Cheng contributed equally to this work. Normal lymphoid tissue is found in your lymph nodes and tonsils. Copyright 2011 Noah B. Sands and Marc Tewfik. d. Tumour cells were positive for C-myc (200 x). Clinically this lesion presented as a painless ulcer, which mimicked carcinoma of the tongue. All gene rearrangement studies were performed according to the standard assay procedure, and the results were interpreted according to the assay instructions as described previously [10]. In the throat, at the base of the tongue, where tongue cancer may develop with few signs and symptoms (hypopharyngeal tongue cancer). 8600 Rockville Pike A clinical note. 3). Antibodies against CD3, CD20, CD4, CD5, CD10, CD21, and CD56 were from Novocastra, Leica Biosystems Newcastle, Ltd. Antibodies of CD79, Bcl-6, Mum-1, c-Myc, Ki-67, and AE1/AE3, ALK were from Invitrogen, USA. Case report: A 53-year-old female presented with globus sensation, mild dysphagia, nocturnal breathing problems and 'hot . 5760, 1993. government site. Epub 2016 Sep 17. The https:// ensures that you are connecting to the Healy JA, Dave SS. Disclaimer. Patient ages ranged from the thirties to the nineties, with an average age of 61.8years. https://doi.org/10.1002/cncr.27988. Of the DLBCL patients, 4 were not otherwise specified lymphomas (NOS) and 1 was T cell/histiocyte rich large B-cell lymphoma. Clinical images of entities may be beneficial for documentation purposes, as they may be viewed during future appointments should there be recurrences. Severe HBT was considered to be present when the follicles prevented the view of the epiglottis or were massively distributed through the pharynx and larynx. XR and YC wrote the article. Objective: This paper describes a case where a patient diagnosed with tongue base lymphoid hyperplasia was successfully treated with radiofrequency excision and interstitial radiofrequency-induced thermotherapy. In special cases, several biopsies are needed. 2015;390:31537. https://doi.org/10.1016/j.anndiagpath.2005.09.020. J Laryngol Otol. One case was P53 positive (Fig. Two patients survived more than six years. Tracheotomy was performed to relieve respiratory oppression. Guastafierro S, Falcone U, Celentano M, Cappabianca S, Giudice A, Colella G. Primary mantle-cell non-Hodgkin's lymphoma of the tongue. [Diagnostics of laryngopharyngeal form of gastroesophageal reflux disease for adults (Lithuanian clinical practice guidelines)]. The presence of an excessively large tongue, which may be congenital or may develop as a result of a tumor or edema due to obstruction of lymphatic vessels, or it may occur in association with hyperpituitarism or acromegaly. Rasmussen PK. These cells are designed to fight. What are chaces of malignancy?What precautions for future shud i take? Paraffin sections were prepared according to the ThermoBrite Elite Automated FISH slide prep system manufacturers protocol. EBV ISH was performed using EBV-encoded Small RNA (EBER) probes (Bond ready-to-use ISH, Catalogue No: PB0589, Leica Biosystems Newcastle, Ltd.) according to the manufacturers protocol. 2009 Sep;114(6):948-59. doi: 10.1007/s11547-009-0416-4. All 7 lymphomas were localized at the base of the tongue. Authors M Gromet , M J Homer , B L Carter PMID: 7111732 DOI: 10.1148/radiology.144.4.7111732 No abstract available Publication types Case Reports MeSH terms Adult Barium Sulfate Deglutition Diagnosis, Differential Female Thus, Thus, in the early stages, such tumours are misdiagnosed as infectious or proliferative lesions. Clinical information and disease characteristics are described in Table1. Nathu RM, Mendenhall NP, Almasri NM, Lynch JW. Hi, my biopsy says reactive lymphoid hyperplasia, does it means it is benign? Head and neck extranodal lymphoma in a single institute: a 17-year retrospective analysis. Imaging examination and tissue biopsy should be performed as early as possible to improve precise pathological diagnosis and therapeutic outcomes. At the time of induction, our service was called emergently due to failed intubation related to a pharyngeal mass.. There were two main cytomorphological variants of the DLBCL, NOS cases: centroblastic and immunoblastic. Article https://doi.org/10.4103/0019-509X.58873. The site is secure. Google Scholar. Benign Lymphoid Hyperplasia of the Tongue Base Causing Upper Airway Obstruction Severe benign lymphoid hyperplasia (LH) is unusual in the head and neck region, but the diagnosis of LH is of clinical importance as it may be confused with malignant lymphoma, both on clinical examination and pathologically. Get answers from Oncologist and Hematologists and top U.S. doctors, Our doctors evaluate, diagnose, prescribe, order lab tests, and recommend follow-up care. HPV is considered to be associated with the occurrence of oropharyngeal squamous cell carcinoma [8], therefore, we detected the infection status of the the two viruses in lymphoma of the base of the tongue. Vega F, Lin P, Medeiros LJ. Video chat with a U.S. board-certified doctor 24/7 in a minute. Tongue musculature involvement can cause restricted movement, dysarthria, and dysphagia. Studies on the survival time for patients with DLBCL in the head and neck are controversial [24, 36, 37]; here, we added that lymphoma arising from the base of the tongue has a good prognosis. 2010;47:846. The https:// ensures that you are connecting to the Expression of c-Myc and p53 correlates with clinical outcome in diffuse large B-cell lymphomas. [citation needed], Paracortical hyperplasia is the preferential stimulation of the T cell compartment. ZL did the T-Cell Receptor and Immunoglobulin Gene Rearrangement Studies. In addition, HPV-positive tumours are a unique clinical entity distinct from HPV-negative tumours [30], and involve, for instance, less exposure to tobacco. PubMed Central Only one widely disseminated case has been referenced, which involved cervical nodes, major salivary glands, orbits, and mediastinum [4]. Final pathology was determined on postoperative day (POD) 2 to be benign follicular/intrafollicular lymphoid hyperplasia characterized by polyclonal lymphoid proliferation with an inflammatory background. The clinical stage was IV A by the Ann Arbor staging system. Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry using a tissue microarray. One patient in the literature died 18months after diagnosis despite being in an early stage. The tumour cell composition of MCL varies greatly in the literature, from small cells with slightly irregular nuclei to large cells similar to the large cells in DLBCL, which could be misdiagnosed as DLBCL. e. Tumour cells were positive for CD4 (200x). Please enable it to take advantage of the complete set of features! All cases were negative for EBV ISH but one case was positive for HPV DNA ISH while the other six cases were negative for HPV DNA ISH. https://doi.org/10.1007/s00428-014-1682-7. CT scan in the axial plane revealing near-complete airway obstruction at the level of the oropharynx. Polyclonal lymphoid proliferation with immunohistochemistry stains for kappa or lambda light chains are diagnostic. c. Immunohistochemistry staining showed diffuse and strong staining of P16 protein (40 x) d. Immunohistochemistry staining showed diffuse and strong staining of P16 protein (100 x). All authors read and approved the final manuscript. 2002;15:4205. [citation needed], Sinus hyperplasia is the preferential stimulation of the histiocytic (tissues macrophage) compartment. [citation needed], Cutaneous lymphoid lesions may be observed in follicular, granulomatous or lymphoreticular pathologic patterns. 2. 1, pp. Ear Nose Throat J. Oral Surg Oral Med Oral Pathol Oral Radiol. DLBCL with high risk factors and MCL may have unfavourable outcomes. Samples were assayed using a BOND HPV probe set specific to HPV subtypes 16, 18, 31, 33 and 51 (Bond Ready-to-Use ISH HPV Probe, CAT # PB0829) on the Leica BOND-MAX system. Upon examination with direct laryngoscopy a large, multiloculated, exophytic mass was identified, emanating from the oropharynx and extending distally to the level of the supraglottis, occupying >90% of the upper aerodigestive tract. Federal government websites often end in .gov or .mil. 1993;189:30011. A final diagnosis was made through deep resection. Briefly, the criteria and parameters for diagnosing and evaluating our cases were as follows: lymphoma classifications were based on the World Health Organization Classification of Tumors of Hematopoietic and Lymphoid Tissues (Revised Fourth Edition), and staging was based on the Ann Arbor Staging System. Would you like email updates of new search results? [36] showed that patients with DLBCL located on Waldeyers ring (base of the tongue) often have a better prognosis than nodal DLBCL patients. Overall survival was calculated from the date of diagnosis to the date of either death or the latest follow up. PMC Lymphoma is the second most common primary malignancy occurring in the head and neck behind squamous cell carcinoma, while NHL accounts for 6590% of all lymphomas occurring in the head and neck [1, 2] .2030% of NHLs are derived from extra-nodal sites [3] .Nonetheless, NHL with a primary site in the oral cavity is rare, and in the tongue base, even rarer [4, 5]. Differential diagnoses include benign lymphoid hyperplasia and carcinoma. Unable to load your collection due to an error, Unable to load your delegates due to an error. or a reactive lymphoid proliferation to an unknown antigenic stimulation [2]. Before The tongue has a rich network of lymphatics that drain to neck levels I-III, which is the usual pattern of spread when these tumors metastasize. Most DLBCL cases of the tongue base had no Bcl-2, Bcl-6, or c-Myc rearrangement and they were sensitive to rituximab. The term reactive lymphoid hyperplasia (RLH) is used as a general term to describe these types of lymphoid proliferations. This might be because HPV subtype for this patient is different and is not covered by RNAscope HPV HR 18(RS-8002),or this case is a little bit old and RNA was not well preserved in formalin-fixed, paraffin-embedded tissue blocks. Follicular lymphoid hyperplasia (FLH) is an uncommon benign entity related to a rapid increase in the abundance of lymphocytes contained within or outside of lymph nodes. 1),and two cases expressed c-Myc(>40%). 1984 Apr;151(1):123-6. doi: 10.1148/radiology.151.1.6322222. 1998;112:9914. 88, no. Chang CC, Liu YC, Cleveland RP, Perkins SL. Ezzat AA, Ibrahim EM, El Weshi AN, Khafaga YM, AlJurf M, Martin JM, Ajarim DS, Bazarbashi SN, Stuart RK, Zucca E. Localized non-Hodgkin's lymphoma of Waldeyer's ring: clinical features, management, and prognosis of 130 adult patients. Other rare case reports describe upper airway obstruction[4] and systemic autoimmune disease.[5]. A lymphoid follicle under microscope is shown in Figure 2. These tonsils contain B and T lymphocytes which get activated when harmful bacteria and viruses come in contact with tonsils. The diagnosis of FLH is of clinical importance as it may be confused with malignant lymphoma, both on clinical examination and histopathology. Tonsils and the throat-lingual tonsils labelled Like other lymphatic tissues, the function of lingual tonsils is to prevent infections. 2). Primary diffuse large B-cell lymphoma of the ovary is of a germinal Centre B-cell-like phenotype. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Squamous cells also make up the top layer of skin and other body parts such as the lungs and esophagus. Dr. Tarik Hadid answered Internal Medicine - Hematology & Oncology 20 years experience Benign: It means that there is an increase of the number of a type of white blood cells called lymphocytes. All rights reserved. 2006;17:143440. Then he looked down my throat through my nose. CAS The possible reason was that the patient had several high risk factors, such as old age (in his nineties), positivity for c-Myc and P53, and co-expression of c-Myc (50%), Bcl-2 and Bcl-6 [38]. A minute Paracortical hyperplasia is generally not malignant, but in rare cases an association has been observed immunoblastic! System manufacturers protocol the throat-lingual tonsils labelled like other lymphatic tissues, the inner cortex has cells! 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