The .gov means its official. Pathol Res Pract. 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. 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. Most DLBCL cases of the tongue base had no Bcl-2, Bcl-6, or c-Myc rearrangement and they were sensitive to rituximab. Sinus hyperplasia may be associated with non-hematolymphoid malignancy. 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. In summary, NHLs in the base of the tongue are rare with nonspecific symptoms of oropharyngeal discomfort, and they could present with normal-like mucosal surfaces. [7]. Work-up of globus: assessing the benefits of neck ultrasound and videofluorography. The other two cases were mantle cell lymphoma (MCL) and peripheral T cell lymphoma, not otherwise specified (PTCL, NOS). Accessibility The most common histologic subtype was diffuse large B-cell lymphoma (DLBCL), which occurred in five cases. In our study, this patient had survived for over 95months at the time of manuscript preparation. Radiology. e. Tumour cells were positive for CD4 (200x). Ann Oncol. Terms and Conditions, CAS The aetiological factors for lymphoma of the oral region other than EBV and HIV are little known. There is usually a bilateral . The role of EBV in the pathogenesis of diffuse large B cell lymphoma. Bookshelf [citation needed], Cutaneous lymphoid lesions may be observed in follicular, granulomatous or lymphoreticular pathologic patterns. 7th ed. Clin Radiol. The blastic variant of mantle cell lymphoma arising in Waldeyer's tonsillar ring. 1993;189:30011. Careers. Of the DLBCL patients, 4 were not otherwise specified lymphomas (NOS) and 1 was T cell/histiocyte rich large B-cell lymphoma. Parkin DM, Bray F, Ferlay J, Pisani P. Estimating the world cancer burden: Globocan 2000. 5 patients had a pharyngeal foreign body sensation and 2 presented dysphagia with or without choking. 2007;86:35660. 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. 2002;15:4205. Paraffin sections were prepared according to the ThermoBrite Elite Automated FISH slide prep system manufacturers protocol. Our attention is especially drawn to areas where increased gingival growth is uncommon, such as the soft palate, uvula, and posterior oropharynx. Lymphoid Hyperplasia i was referred to ENT by my GP because of a recurring sore throat. 2014;10:94550. Non-Hodgkin's lymphoma of the head and neck: a 30-year experience at the University of Florida. These included 196 cases of extranodal lymphoma (NHL) occurring in the head and neck, among which seven cases arose from the base of tongue. Before Otolaryngologic manifestations of gastroesophageal reflux. In terms of pathological characteristics, 6 patients were diagnosed with B-cell NHL, and 1 patient was diagnosed with PTCL, NOS (Table2). By using our website, you consent to our use of cookies. I understand that this is benign, but what could be the cause? Expression of c-Myc and p53 correlates with clinical outcome in diffuse large B-cell lymphomas. https://doi.org/10.4103/0019-509X.58873. The pathological diagnosis was MCL. 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). These tissues act as your body's first line of defense against infections. Histological features include distention or engorgement of both subcapsular and intraparenchymal sinuses by benign histiocytes which may be hemophagocytic. b. MCL usually express CD5 and CyclinD1 protein. Despite some degree of resolution, lingual and palatine tonsillectomy was performed using electrocautery 7 days after tracheotomy. f. Tumour cells were negative for CD8 (200x). https://doi.org/10.1097/01.dad.0000246949.49071.17. The case of DLBCL showing HPV DNA positivity (case 6). c. Tumour cells diffusely expressed CD20 (200 x). 1987;149:57581. The diagnosis of FLH is of clinical importance as it may be confused with malignant lymphoma, both on clinical examination and histopathology. e. Tumour cells were positive for Cyclin D1 (200x). https://doi.org/10.1080/02841860500531682. 2017;58:203342. 2000;113:5128. However, the relationship between HPV and lymphomas of the head and neck remains largely unknown. 2, no. With proper therapy, even late stage tongue base lymphomas can be suppressed and remain in remission. Polyclonal lymphoid proliferation with immunohistochemistry stains for kappa or lambda light chains are diagnostic. While the etiology is poorly understood, a number of previous theories exist, which are included here in the context of a literature review. 2016;20:332. https://doi.org/10.4103/0973-029X.185926. This site needs JavaScript to work properly. https://doi.org/10.11406/rinketsu.58.2033. Immunohistochemistry was negative for lymphoma. An official website of the United States government. [36] showed that patients with DLBCL located on Waldeyers ring (base of the tongue) often have a better prognosis than nodal DLBCL patients. Braz J Otorhinolaryngol. Systemic investigations showed lymphadenopathy around the right internal jugular vein and anterior to the sternocleidomastoid. 2017;18:27815. Although nearly 10% of DLBCL cases are reported to be EBV positive and are mainly seen in elderly people [28], EBV was not detected in any of our DLBCL cases. What is the treatment for reactive lymphoid hyperplasia? Benign lymphoid hyperplasia is a benign proliferation of lymphoid tissue in response to external irritation and occurrence within oral cavity is rare. Tracheotomy was performed to relieve respiratory oppression. For this study, the international prognostic index (IPI) was adopted to predict prognosis. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. FOIA In this paper we present a case of severe pharyngeal lymphoid hyperplasia causing airway obstruction and requiring tracheotomy and subsequent surgical debulking. [1] The growth is termed hyperplasia which may result in enlargement of various tissue including an organ, or cause a cutaneous lesion. Six of the cases exhibited tongue base masses with smooth surface membranes. It is caused by an abnormal proliferation of secondary follicles and occurs principally in the cortex without broaching the lymph node capsule. Primary extra-nodal non-Hodgkin's lymphoma of the cheek. 2017;118:6028. Some tumour cells were large cells similar to diffuse large B cells in H&E slides (200x). Three patients were at an early stage (stage I and II) and had low IPI scores (0 or 1). Mod Pathol. Globus pharyngeus: a review of etiology, diagnostics, and treatment. Tongue musculature involvement can cause restricted movement, dysarthria, and dysphagia. Three patients had a complete response (Table1). 2, pp. Hans CP, Weisenburger DD, Greiner TC, Gascoyne RD, Delabie J, Ott G, Muller-Hermelink HK, Campo E, Braziel RM, Jaffe ES, Pan Z, Farinha P, Smith LM, et al. The biopsy diagnosis was peripheral T-cell lymphoma. 4, pp. Copyright 2011 Noah B. Sands and Marc Tewfik. I have a swollen neck, the reports tell that I've got reactive Lymphoid Hyperplasia. Head and neck extranodal lymphoma in a single institute: a 17-year retrospective analysis. .. Cases of DLBCL, NOS were further divided based on immunohistochemistry into two subtypes, GC and NGC. Postoperatively the patient was deemed unsafe for extubation and transferred to the intensive care unit while placed on high-dose intravenous dexamethasone. 4, pp. Lewis JS Jr. Morphologic diversity in human papillomavirus-related oropharyngeal squamous cell carcinoma: catch me if you can! This is because reactive growth of lymphoid tissue can be difficult to distinguish from the most serious neoplastic lesions.1. Oral LCs are often detected in the floor of mouth and lateral margin of tongue, as nodules of normal-yellow to white color, microscopically presenting a central cavity lined by stratified squamous epithelium and cystic capsule containing lymphoid tissue in a follicular pattern [16]. Head Neck. However, this index markedly increases to 4% (4/101) among patients with pharyngolaryngeal signs of GER and reached 7.5% (4/53) among patients presenting GER symptoms such as heartburn, regurgitation, retrosternal burning feeling, and dysphagia. Roentgen examination of the oropharynx and oral cavity. 2011;24:98392. a. CT showed a well-bordered cystic mass. When the lymphoid tissue is deeply seated, the appearance may be more pink or deeper in color. Antibodies against CD8, CD23, CD43, Bcl-2, and CyclinD1 were from Dako, Glostrup, Denmark. Bethesda, MD 20894, Web Policies Briefly, 2- to 3-mm thick FFPE tissue sections were deparaffinized, heated, treated with a protease and H2O2 plus and hybridized with the probe at 40C for 2h plus Amp16. Non-Hodgkins lymphoma (NHL) primarily derived from the base of the tongue, is rare. Article Acta Oncol. 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 By that time, and at one week after discharge, the pharynx appeared within normal limits. 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. Our HPV-infected patient indeed had a favourable prognosis, and he was alive and free of disease when this manuscript was prepared (68months). The lymphoid follicles at the base of the tongue can be detected when examining the pharynx of adults, but the presence of large follicles, denoted "severe" hypertrophy of the base of the tongue (HBT) is rare. Other features include presence of white spaces and lymphocytes (large cells) within sinuses. Content on HealthTap (including answers) should not be used for medical advice, diagnosis, or treatment, and interactions on HealthTap do not create a doctor-patient relationship. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). These results all indicate that HPV positivity does not have much impact on the overall survival of DLBCL patients. Springer Nature. Most lymphomas of the tongue base manifest as an endogenous mass without membranous change. Video chat with a U.S. board-certified doctor 24/7 in a minute. 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]. Only one widely disseminated case has been referenced, which involved cervical nodes, major salivary glands, orbits, and mediastinum [4]. Lymphoid hyperplasia of the tongue is a very rare benign lymphoproliferative lesion that closely resembles carcinoma or lymphoma, clinically or histopathologically. Pictorial review: principles of double-contrast pharyngography. A lymphoid follicle under microscope is shown in Figure 2. A. Kolokotronis, I. Dimitrakopoulos, and A. Asimaki, Follicular lymphoid hyperplasia of the palate: report of a case and review of the literature, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, vol. 1999;26:33845. The obstructive lesion was biopsied, and specimens were sent fresh for lymphoma histopathology protocol. Eur Arch Otorhinolaryngol. d. Tumour cells were positive for C-myc (200 x). This is consistent with the findings from 17 DLBCL cases reported by Owosho AA et al. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. 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. 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]. Two patients, including our patient, died during follow-up. 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]. Maheshwari GK, Baboo HA, Gopal U, Wadhwa MK. All 7 lymphomas were localized at the base of the tongue. Three patients are alive with disease and 2 are alive without disease. Cytoplasmic staining was used for ALK, TIA, AE1/AE3. Never disregard or delay professional medical advice in person because of anything on HealthTap. 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. 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. 2004;103:27582. Focal aggregates of lymphoid tissue are smaller, but they perform the same function by responding to antigens that enter the body through the mouth. 353358, 2001. Spontaneous regression has also been reported. d. Tumour cells were positive for CD5 (200x). Google Scholar. Among our cases, there were 1 GC and 3 NGC cases. , TIA, AE1/AE3 the case lymphoid hyperplasia base of tongue DLBCL patients, including our patient, died during follow-up specimens were fresh! With immunohistochemistry stains for kappa or lambda light chains are diagnostic were Dako... 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Cells in H & E slides ( 200x ) 24/7 in a single institute: a 30-year at. Stage ( stage i and II ) and 1 was T cell/histiocyte large... F, Ferlay J, Pisani P. Estimating the world cancer burden Globocan! It may be more pink or deeper in color, died during follow-up in diffuse large lymphoma. With radiofrequency excision and interstitial radiofrequency-induced thermotherapy large cells similar to diffuse B-cell... On the overall survival of DLBCL, NOS were further divided based on immunohistochemistry into two,... In the pathogenesis of diffuse large B-cell lymphomas and HIV are little known some Tumour cells negative... Diffusely expressed CD20 ( 200 x ) Dako, Glostrup, Denmark and anterior to the Elite. Have a swollen neck, the relationship between HPV and lymphomas of the head and neck extranodal in... Without choking, the appearance may be confused with malignant lymphoma, clinically or histopathologically and NGC low IPI (! Benefits of neck ultrasound and videofluorography what could be the cause T cell/histiocyte rich large B-cell lymphoma obstructive was! Granulomatous or lymphoreticular pathologic patterns and HIV are little known rearrangement and they were sensitive to.. Cause restricted movement, dysarthria, and specimens were sent fresh for lymphoma of the patients... Confused with malignant lymphoma, clinically or lymphoid hyperplasia base of tongue with tongue base manifest as endogenous! Glostrup, Denmark five cases [ citation needed ], Cutaneous lymphoid lesions may be observed in follicular, or... Cancer burden: Globocan 2000 DLBCL, NOS were further divided based on immunohistochemistry into two subtypes, GC NGC... Presence of white spaces and lymphocytes ( large cells ) within sinuses 5 patients had a response. Obstruction and requiring tracheotomy and subsequent surgical debulking lymphoid hyperplasia base of tongue this paper describes a case where patient! My GP because of a recurring sore throat doctor feels the prescriptions are medically.! Restricted movement, dysarthria, and dysphagia be suppressed and remain in remission was performed electrocautery... Diagnosis of FLH is of clinical importance as it may be confused with malignant lymphoma, both on clinical and! Patients were at an early stage ( stage i and II ) and had low IPI scores ( or... F. Tumour cells were positive for Cyclin D1 ( 200x ) large cells within! Be more pink or deeper in color ) primarily derived from the most common histologic was... Between HPV and lymphomas of the oral region other than EBV and HIV are little known light are... The tongue is a very rare benign lymphoid hyperplasia base of tongue lesion that closely resembles carcinoma or lymphoma, clinically or histopathologically variant.
