Primary mantle cell lymphoma of the tonsil: An uncommon case
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CASE REPORT
Primary Mantle Cell Lymphoma of the Tonsil: An Uncommon Case T. Vasilakaki, A. Tsavari, E. Arkoumani, K. Koulia, K. Manoloudaki, A. Marinis, K. Stamatiou
Abstract Non-Hodgkin lymphoma of the Waldeyer’s ring is a relatively rare entity and the palatine tonsil is the most frequently involved site. Although the exact aetiology remains unclear, a number of predisposing factors have been identified including human immunodeficiency virus and Epstein-Barr infection. An 82-year-old male patient presented with a sensation of fullness of the throat. Physical examination revealed a smooth non-tender mass in the right palatine tonsil measuring approximately 3.5 x 3cm. Serology was negative for human immunodeficiency virus and EpsteinBarr virus. Computer tomography revealed a non-enhancing right tonsillar mass but without any signs of neck lymphadenopathy. The patient underwent bilateral tonsillectomy. Histological examination confirmed a diagnosis of mantle cell lymphoma of B phenotype. Immunohistochemically, the neoplastic cells were positive for CD19, CD20, CD79a, CD22, Bcl 2, CD5, Cyclin D1 and negative for CD10, CD57, EBV, CD3, CKAE1, CKAE3. Bone marrow biopsy did not reveal lymphomatous involvement. The patient received chemotherapy based on CHOP protocol combined with Rituximab. At 18-month follow-up after diagnosis, he remains disease-free. Non-Hodgkin lymphomas rarely involve the tonsils and the vast majority of them are of B-cell origin. A combined treatment consisting of chemotherapy and radiotherapy leads to a satisfactory outcome in patients with this uncommon neoplasm. The current results supported its good prognosis at early stage. Key words: Non-Hodgkin lymphoma; tonsil; mantle cell lymphoma
Introduction
Case Presentation
Non-Hodgkin lymphoma (NHL) of the oral cavity and oropharynx account for 13% of all primary extranodal NHLs with approximately 70% of these occurring in the tonsils. The palatine tonsil is the most frequently involved site followed by the palate, gingiva and tongue [1, 2]. Most lymphomas found in the palatine tonsils are the B-cell type, and of these diffuse large B-cell lymphoma (DLBCL) represents the majority, reaching as much as 80% in some of the groups studied [1, 3]. Mantle cell lymphoma is the second most common (10%).
We report the case of an 82-year-old male patient who presented with a sensation of fullness of the throat during the last six months. Physical examination revealed an approximately 3.5cm x 3cm smooth non-tender mass in the right palatine tonsil. Laboratory studies for tumour markers and serology tests for human immunodeficiency virus and Epstein-Barr virus were negative. Computed tomography revealed a non-enhancing right tonsillar mass but without signs of neck lymphadenopathy. Past history did not appear to be contributory regarding the aetiology. The patient underwent bilateral tonsillectomy. Histological examination confirmed a diagnosis of mantle cell lymphoma of B phenotype. The stroma was densely infiltrated by monotonous small to medium-sized lymp
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