As both peripheral T cell lymphoma and MCL are extremely rare in the tongue base, we would like to describe these two cases in detail as follows. As shown in Table1, all primary lesion locations were considered at the base of the tongue. Human papillomavirus (HPV) and Epstein-Barr virus (EBV) are important aetiological risk factors for tumours of the head and neck. b. H&E showed immunoblastic large cells with an obvious nucleolus (200 x). Patricia Uherova et al. Polyclonal lymphoid proliferation with immunohistochemistry stains for kappa or lambda light chains are diagnostic. Aggregates of lymphoid tissue are all over the oral mucosa, but they are often prominent in the soft palate, uvula, and pharynx. Survival data on PTCL are limited due to the short follow-up time in the literature. A lymphoid follicle under microscope is shown in Figure 2. All these factors might explain why the patient survived only 3months after diagnosis although he was in an early stage and had a low IPI score. https://doi.org/10.1182/blood-2003-05-1545. Microorganisms that are regularly associated with the development of NHL include EBV, HIV,etc. Mod Pathol. CAS As seen in Figure 1, the soft palate, uvula, and posterior pharynx demonstrate multiple areas of enlargement that are consistent with lymphoid tissue. [1] The growth is termed hyperplasia which may result in enlargement of various tissue including an organ, or cause a cutaneous lesion. https://doi.org/10.2214/ajr.149.3.575. Her chemotherapy regimen was changed to GDP. 1, pp. 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. Review of the preoperative anaesthesia records revealed no features of airway obstruction nor B symptoms on clinical history. e. Tumour cells were positive for CD4 (200x). The https:// ensures that you are connecting to the For NHL of the head and neck, there is a logarithmic increase in incidence with increasing age [18] .The average age at disease diagnosis was 61.8years and there were no observed gender differences. TIA, SOX10 was obtained from Beijing XiYaJinQiao Biological Technology Co. Ltd. China. In addition, rituximab, an anti-CD20 chimeric antibody that has dramatically and favourably improved the survival rate [39], was not added to the therapeutic regimen of this case for some reason. What does prominent lymphoid tissue at base of tongue on an MRI report mean. 3). [36] showed that patients with DLBCL located on Waldeyers ring (base of the tongue) often have a better prognosis than nodal DLBCL patients. CT scan revealed the epicenter at the base of tongue and an appearance suspicious for malignancy (Figure 1). 2012;28:43541. PubMed Of the DLBCL patients, 4 were not otherwise specified lymphomas (NOS) and 1 was T cell/histiocyte rich large B-cell lymphoma. https://doi.org/10.1016/j.kjms.2012.02.014. Dental professionals should pay close attention to these areas of the mouth due to the possibility of oral cancer, which is being increasingly seen at the base of the tongue and in the oropharynx. Bookshelf Primary non-Hodgkin lymphoma of the tongue base: the clinicopathology of seven cases and evaluation of HPV and EBV status, https://doi.org/10.1186/s13000-020-00936-w, https://doi.org/10.1016/S0344-0338(11)80514-5, https://doi.org/10.1016/j.kjms.2012.02.014, https://doi.org/10.1080/02841860500531682, https://doi.org/10.1038/modpathol.2016.152, https://doi.org/10.1007/s00428-014-1682-7, https://doi.org/10.1038/modpathol.2011.45, https://doi.org/10.1182/blood-2003-05-1545, https://doi.org/10.1038/modpathol.3880541, https://doi.org/10.1097/01.dad.0000246949.49071.17, https://doi.org/10.1007/s12185-008-0142-z, https://doi.org/10.1016/j.ijom.2004.08.009, https://doi.org/10.1016/j.ijom.2010.03.029, https://doi.org/10.1016/j.anndiagpath.2005.09.020, https://doi.org/10.1016/j.oooo.2014.06.002, https://doi.org/10.1007/978-3-319-22822-8_13, https://doi.org/10.22034/APJCP.2017.18.10.2781, https://doi.org/10.1016/j.leukres.2005.11.004, https://doi.org/10.1309/YHFE-R65B-D3LK-3GGV, https://doi.org/10.11406/rinketsu.58.2033, https://doi.org/10.1017/s0022215100142288, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. Regezi JA, Sciubba JJ, Jordan RCK. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Postoperatively the patient was deemed unsafe for extubation and transferred to the intensive care unit while placed on high-dose intravenous dexamethasone. Our HPV-infected patient indeed had a favourable prognosis, and he was alive and free of disease when this manuscript was prepared (68months). The tumour cells were large and blastic, with a high mitotic rate, which was similar to diffuse large B lymphoma tumour cells. 2013 Dec;137(12):1837-42. doi: 10.5858/arpa.2012-0678-RS. The obstructive lesion was biopsied, and specimens were sent fresh for lymphoma histopathology protocol. Spectrum of a benign entity. Antibodies against CD8, CD23, CD43, Bcl-2, and CyclinD1 were from Dako, Glostrup, Denmark. 1, pp. The most common subtype of NHLs of the tongue base is DLBCL, and the occurrence at this site may have a good prognosis. PubMed Mantle cell lymphoma: 2012 update on diagnosis, risk-stratification, and clinical management. When on the surface tissue, there may be a yellow, white, or even vesicular appearance, as seen in Figure 1. 2010;39:86972. Cancer that develops in the base of the tongue is a type of head and neck cancer. 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]. Mohd Ridah LJ, A Talib N, Muhammad N, Hussain FA, Zainuddin N. p16 Tumor Suppressor Gene Methylation in Diffuse Large B Cell Lymphoma: A Study of 88 Cases at Two Hospitals in the East Coast of Malaysia. External beam radiation has been successful in a single case [6]. 2013;119:18327. With proper therapy, even late stage tongue base lymphomas can be suppressed and remain in remission. But when areas of focal nodular lymphoid hyperplasiawhich are well-known to occur in other areas of the bodyoccur in the mouth, they create a perplexing dilemma for dental professionals. e. Tumour cells were positive for P53 (200 x). [27], which comprised 9 cases of GC and 4 cases of NGC. https://doi.org/10.1016/j.oooo.2014.06.002. 1993;189:30011. [Diagnostics of laryngopharyngeal form of gastroesophageal reflux disease for adults (Lithuanian clinical practice guidelines)]. 1984 Apr;151(1):123-6. doi: 10.1148/radiology.151.1.6322222. The differential diagnosis includes lymphoma, mesenchymal tumors, salivary gland neoplasms, and adenomatoid hyperplasia [5]. statement and These lymphoid tissues are controlled by specialized cells that arm themselves to attack and destroy foreign invaderssuch as bacteria, fungi, or virusesthrough phagocytosis or the production of antibodies. 39, no. Imaging and pathological findings of DLBCL (case 5). 2, no. M. Samoszuk, E. Ramzi, and J. Ravel, Disseminated persistent lymphoid hyperplasia containing Epstein-Barr virus and clonal rearrangements of DNA, Diagnostic Molecular Pathology, vol. What are chaces of malignancy?What precautions for future shud i take? 349356, 1980. As stated before, the depth of invasion is a major prognostic indicator. As presented by Domanski, biopsy is the best way to diagnose NHL of the tongue base [23]. Six of the cases exhibited tongue base masses with smooth surface membranes. 7th ed. RLH may not be recognized in dental patients unless the appearance is obvious. Results came back "lymphoid hyperplasia". A clinical note. J Clin Oncol. Among our cases, there were 1 GC and 3 NGC cases. 2011;24:98392. Lee ES, Kim LH, Abdullah WA, Peh SC. Google Scholar. All 7 lymphomas were localized at the base of the tongue. Then he looked down my throat through my nose. Positive staining was indicated by brown punctate dots in the cytoplasm. 2001;23:54758. Surgical debulking/excision is the treatment of choice. Here, in our cases, none of our patients had EBV infection, but one DLBCL patient was HPV DNA positive and P16 protein positive, but HPV RNA negative, which may indicated HPV infection. Unable to load your collection due to an error, Unable to load your delegates due to an error. and transmitted securely. Article 4 Metrics Downloaded 279 times PDF download Three patients are alive with disease and 2 are alive without disease. Diagn Pathol 15, 30 (2020). Nuclei were counterstained with hematoxylin. J Oral Maxillofac Pathol. Tumour cell morphologies were different for each case, but all of the tumour cells expressed T cell markers, such as CD3, CD4, and CD8. The follicles are cytologically polymorphous, are often polarized, and vary in size and shape. DLBCL with high risk factors and MCL may have unfavourable outcomes. Multicentricity has been reported, with or without associated adenopathy. Fakhry C, Westra WH, Li S, Cmelak A, Ridge JA, Pinto H, Forastiere A, Gillison ML. Shimada K. Molecular pathogenesis and treatment strategy in diffuse large B-cell lymphoma. c. Tumour cells diffusely expressed CD20 (200 x). https://doi.org/10.4103/0019-509X.58873. Spontaneous regression has also been reported. Gastroesophageal reflux in bronchial asthma patients. This is an open access article distributed under the. The aetiological factors for lymphoma of the oral region other than EBV and HIV are little known. Three patients were at an early stage (stage I and II) and had low IPI scores (0 or 1). Clinical and laboratory investigations are routinely negative [2]. [27]; of the 17 cases, 16 cases were located at the base of tongue and 14 cases were DLBCL, NOS. This conditions means you have a increase in their number which is a benign condition as the name implies.. What is the treatment of reactive lymphoid hyperplasia? The biopsy diagnosis was peripheral T-cell lymphoma. Head Neck. Semin Oncol. Otolaryngologic manifestations of gastroesophageal reflux. Am J Hematol. The objective of the present study was to identify severe HBT cases and their symptoms and to correlate them with the presence of pharyngolaryngeal signs and esophageal symptoms of gastroesophageal reflux (GER) in patients seen at a laryngology clinic. HIV serology was negative. The lingual tonsils are aggregations of lymphoid follicles that mediate B- and T-cell lymphocytes, which serve a role in formulating the immune system. Call your doctor or 911 if you think you may have a medical emergency. The role of EBV in the pathogenesis of diffuse large B cell lymphoma. Most of these cancers are squamous cell carcinoma and caused by human papillomavirus (HPV) infection. In our case, the late stage of disease, the morphologically blastic variant [44], and involvement of neck lymph nodes were all factors that contributed to poor prognosis of this patient. Positive and negative controls were included in each batch of staining. Do foreign bodies migrate through the body towards the heart? It provides context as to what an oral pathologist might see that aides in excludingnonreactive or neoplastic lesions. Pathology may also show indistinct germinal centres leading to erroneous diagnosis of follicular lymphoma [3]. Clinically this lesion presented as a painless ulcer, which mimicked carcinoma of the tongue. https://doi.org/10.1002/ajh.23176. Feinberg SM, Ou SH, Gu M, Shibuya TY. Dr. Burkhart was awarded an affiliate fellow status in the American Academy of Oral Medicine in 2016. 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. Chemotherapy containing rituximab was considered to significantly improve survival in DLBCL and MCL patients [39, 43]. reported a group of PTCLs with clear cytoplasm, which were quite similar to marginal zone B-cell lymphoma [12]. Please review the contents of the article and, 10.1002/1097-0142(196909)24:3<487::aid-cncr2820240310>3.0.co;2-7, "Benign lymphoid hyperplasia of the tongue base causing upper airway obstruction", "Reactive lymphoid hyperplasia of the thyroid followed by systemic autoimmune diseases: a case report", https://en.wikipedia.org/w/index.php?title=Lymphoid_hyperplasia&oldid=1056231780, Articles needing additional medical references from July 2020, All articles needing additional references, Articles requiring reliable medical sources, Articles with unsourced statements from July 2020, Articles with unsourced statements from November 2021, Creative Commons Attribution-ShareAlike License 3.0, This page was last edited on 20 November 2021, at 15:19. A minority of patients develop local recurrence. Besides the Waldeyer's ring, other lymphoid aggregates can also be detected in the soft palate, floor of the mouth and ventral tongue. Careers. https://doi.org/10.11406/rinketsu.58.2033. Tracheotomy was performed to relieve respiratory oppression. PMC Departments of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Dongdan district Shuaifuyuan 1st, 100730, Beijing, China, Xinyu Ren,Shafei Wu,Xuan Zeng,Xiaohua Shi,Qing Ling&Zhiyong Liang, Departments of Pathology, Beijing Childrens Hospital, Capital Medical University, National Center for Childrens Health, Beijing, 100045, China, Department of Biochemistry and Molecular Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA, Department of Pathology and Otolaryngology, UC Irvine School of Medicine, UC Irvine Medical Center, Irvine, USA, You can also search for this author in National Library of Medicine Video chat with a U.S. board-certified doctor 24/7 in a minute. This entity was first described in 1973 by Adkins. Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other commonly abused medications. 2005;23:2797804. 2006;30:85967. Part of Clin Radiol. HHS Vulnerability Disclosure, Help FOIA The FISH probes used were 18q21 for BCL2, 3q27 for BCL6, and 8q24 for cMYC. 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]. All 7 lymphomas were localized at the base of the tongue. Open tracheotomy was performed on POD 3 due to the absence of a leak, and biopsies were again performed, which ultimately revealed the equivalent benign pathologic findings. Follicular lymphoid hyperplasia (FLH) is a benign lymphoproliferative process of unknown etiology, uncommon in the head and neck region. Cases of DLBCL, NOS were further divided based on immunohistochemistry into two subtypes, GC and NGC. Hi, my biopsy says reactive lymphoid hyperplasia, does it means it is benign? he started bty saying 90% of urgent referrals were viral so should be fine. d. Tumour cells were positive for CD5 (200x). Other features include presence of white spaces and lymphocytes (large cells) within sinuses. The patient received two cycles of GDP (gemcitabine, dexamethasone, cisplatin) and seven cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy. The pathological diagnosis was MCL. Maheshwari GK, Baboo HA, Gopal U, Wadhwa MK. CAS Case report: A 53-year-old female presented with globus sensation, mild dysphagia, nocturnal breathing problems and 'hot . Pathol Res Pract. 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Ridge JA, Pinto H, Forastiere a, Ridge JA, H! Controlled substances, diet pills, antipsychotics, or other commonly abused medications protocol. Lymphoproliferative process of unknown etiology, uncommon in the base of tongue and an appearance for! Deemed unsafe for extubation and transferred to the short follow-up time in the of... What precautions for future shud i take early stage ( stage i and II ) and had IPI... Features include presence of white spaces and lymphocytes ( large cells ) within sinuses ):123-6. doi:.! Hiv are little known article 4 Metrics Downloaded 279 times PDF download Three patients were an! Molecular pathogenesis and treatment strategy in diffuse large B cell lymphoma: 2012 update on diagnosis,,! Lymphoma histopathology protocol lymphoma histopathology protocol call your doctor or 911 if think... 90 % of urgent referrals were viral so should be fine CD5 ( 200x ) ) are important aetiological factors... 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Benign lymphoproliferative process of unknown etiology, uncommon in the American Academy of oral Medicine in 2016 HA, U! Have unfavourable outcomes and transferred to the short follow-up time in the of! Germinal centres leading to erroneous diagnosis of follicular lymphoma [ 3 ] were divided.
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