Radiol Clin North Am. Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. Almost all cancers in the base of the tongue are squamous cell carcinomas, which form in the thin, flat cells that line the larynx. ZL, BW, XR and YC reviewed all the cases together. b. Tumour cells diffusely expressed CD20 (200 x). [27], which comprised 9 cases of GC and 4 cases of NGC. Yuen A, Jacobs C. Lymphomas of the head and neck. When the lymphoid tissue is deeply seated, the appearance may be more pink or deeper in color. Pictorial review: principles of double-contrast pharyngography. 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. 1970 Dec;8(3):413-24. Increasingly, cancers at the base of the tongue are . Epub 2016 Sep 17. AJR Am J Roentgenol. St. Louis, MO: Elsevier; 2017. 2006;45:25871. Correspondence to Identifying lesions in areas where aggressive lesions may occur and offering patient-centered care can lead to better clinical outcomes. 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]. Lailatul et al. 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. Pathology may also show indistinct germinal centres leading to erroneous diagnosis of follicular lymphoma [3]. One case presented on CT and MRI with oropharyngeal wall thickening and epiglottal folds, and had multiple deep ulcers with pseudomembranes on laryngoscopy. Among our cases, there were 1 GC and 3 NGC cases. Her chemotherapy regimen was changed to GDP. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 1979 Sep;30(5):485-8. doi: 10.1016/s0009-9260(79)80176-2. Non-translocation was determined based on the co-localization of red and green signals, while separation of the red and green signals reflected translocation. Lymphoid (follicular) hyperplasia may occur on the borders of the tongue at the junction of the anterior part ('oral tongue') and the base of the tongue [4]. The complaints due to severe HBT were noisy respiration, hoarseness, throat clearing, dry cough, globus pharyngeus, and nasal voice. The HPV subtype that often infected the cervix, were active but doesnt do much harm to the host because the oral area was not the best breeding site for the virus. Bookshelf 2005;34:3915. Of the 6 B-cell NHL cases, 5 were DLBCLs and 1 was MCL. Review of the preoperative anaesthesia records revealed no features of airway obstruction nor B symptoms on clinical history. e. Tumour cells were positive for Cyclin D1 (200x). Springerplus. Four treatment response classes were defined, as follows: complete response (CR, 100% resolution); partial response (PR, 50100% resolution); no response (<50% resolution); and progression of disease (PD, tumour enlarged after treatment). The HPV ISH positive case also had diffuse and strong expression of P16 protein as revealed by IHC, besides, HPV RNA ISH in this case is negative (Fig. Three patients (cases 1, 2, 7) received R-CHOP, 3 (cases 46) patients received CHOP, and 1 patient (case 3) received GDP and CHOP therapy. Fluorescence in situ hybridization (FISH) analysis using Break Apart FISH Probes was used to detect BCL2, BCL6 and cMYC gene rearrangements. Immunohistochemically, the atypical lymphoid cells were positive for CD20, CD79a, PAX-5, CD5, CyclinD1 protein, and Ki-67 antigen (labelling 25%). Besides the Waldeyer's ring, other lymphoid aggregates can also be detected in the soft palate, floor of the mouth and ventral tongue. 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. Follicular lymphoid hyperplasia (FLH) is a benign lymphoproliferative process of unknown etiology, uncommon in the head and neck region. 2015;390:31537. Non-Hodgkins lymphoma (NHL) primarily derived from the base of the tongue, is rare. Three patients were at an early stage (stage I and II) and had low IPI scores (0 or 1). c. Tumour cell infiltrated squamous epithelium (400x). volume15, Articlenumber:30 (2020) FOIA However, the relationship between HPV and lymphomas of the head and neck remains largely unknown. 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. Squamous cells also make up the top layer of skin and other body parts such as the lungs and esophagus. Epub 2018 Jun 25. Imaging and pathological findings of PTCL (case 3). When oral aggregates appear in clusters or have an unusual appearance or enlargement, clinicians may question whether abnormalities are present. Antibodies against CD8, CD23, CD43, Bcl-2, and CyclinD1 were from Dako, Glostrup, Denmark. Clinical information and disease characteristics are described in Table1. Positive and negative controls were included in each batch of staining. Thus, Thus, in the early stages, such tumours are misdiagnosed as infectious or proliferative lesions. Xinyu Ren and Yin Cheng contributed equally to this work. Accessibility This is consistent with head and neck research findings [6, 26]. Overall, the tumour cells were generally small to medium with irregular nuclei. The other two cases were mantle cell lymphoma (MCL) and peripheral T cell lymphoma, not otherwise specified (PTCL, NOS). 2000;46:2112. 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. Lymphoma cases were selected from 2010 to 2017 in PUMCH, and all cases were reviewed to identify lymphomas arising from the base of the tongue instead of other primary sites. Eur Arch Otorhinolaryngol. There were no c-Myc rearrangements, so there were no double or triple hit B cell lymphomas in these cases (Table3). FOIA Clipboard, Search History, and several other advanced features are temporarily unavailable. Careers. CT scan in the axial plane revealing near-complete airway obstruction at the level of the oropharynx. The tumour cells were large and blastic, with a high mitotic rate, which was similar to diffuse large B lymphoma tumour cells. Does lymphoid hyperplasia and Lymphoma looks the same and is there a threatment for oral Lymphoid Hyperplasia? 2000;21:2716. Cookies policy. [36] showed that patients with DLBCL located on Waldeyers ring (base of the tongue) often have a better prognosis than nodal DLBCL patients. https://doi.org/10.22034/APJCP.2017.18.10.2781. Paracortical hyperplasia may be accompanied by vascular proliferation. Co. Ltd., China. Of the DLBCL patients, 4 were not otherwise specified lymphomas (NOS) and 1 was T cell/histiocyte rich large B-cell lymphoma. This procedure was carried out under general anesthetic in the form of a modified adenotonsillectomy, using a Boyle Davis gag for exposure and a combination of monopolar cautery for the palatine tonsils and suction cautery for subtotal ablation of the lingual tonsils. 2023 Endeavor Business Media, LLC. To the best of our knowledge, four cases have been reported, including our case and three cases from literature (Table 5) [17, 27, 40]. Severe benign LH is unusual in the head and neck region, but the diagnosis should be entertained on the part of the clinician both clinically and histologically when lymphoma is suspectedparticularly in the oral cavity. PubMed A mass was found through radiological and laryngoscopic examinations in six patients. All authors read and approved the final manuscript. 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. One case was P53 positive (Fig. CAS K. F. Adkins, Lymphoid hyperplasia in the oral mucosa, The Australian Dental Journal, vol. The biopsy showed recurrence, with bone marrow involvement. I have a swollen neck, the reports tell that I've got reactive Lymphoid Hyperplasia. In the literature, findings of RLH are well-documented. 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. 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. Lee YY, Van Tassel P, Nauert C, North LB, Jing BS. Am J Hematol. PubMed Central What is the treatment for reactive lymphoid hyperplasia? [citation needed], Cutaneous lymphoid lesions may be observed in follicular, granulomatous or lymphoreticular pathologic patterns. An abstract is unavailable. SW and XZ did the BCL-2, BCL-6, c-MYC FISH examination. The exceptional case here was a 45-year-old male patient with diffuse large B cell lymphoma who presented with only deep painful mouth ulcers and general symptoms, including sore throat, choking when drinking water, and difficulty swallowing. Figure 2 shows the process of a reactive lymphoid lesion histologically. May SA, Jones D, Medeiros LJ, Duvic M, Prieto VG, Lazar AJ. Two patients, including our patient, died during follow-up. Clinical and laboratory investigations are routinely negative [2]. Get answers from Oncologist and Hematologists and top U.S. doctors, Our doctors evaluate, diagnose, prescribe, order lab tests, and recommend follow-up care. MeSH Privacy 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 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. 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. Am J Clin Pathol. 8600 Rockville Pike Do foreign bodies migrate through the body towards the heart? Spontaneous regression has also been reported. 2012;28:43541. Extranodal lymphomas of the head and neck. The number of cases in the present study was low, so further studies will be needed to better understand the relationship between HPV infection and lymphoma of the base of the tongue. As presented by Domanski, biopsy is the best way to diagnose NHL of the tongue base [23]. This entity was first described in 1973 by Adkins. https://doi.org/10.1038/modpathol.3880541. 2005;29:128493. Only one widely disseminated case has been referenced, which involved cervical nodes, major salivary glands, orbits, and mediastinum [4]. 2012;87:6049. A finding indicating enlargement of the tongue. Mod Pathol. It is caused by an abnormal proliferation of secondary follicles and occurs principally in the cortex without broaching the lymph node capsule. The airway was subsequently secured, and the procedure was undertaken. From: The Teaching Files: Chest, 2010 View all Topics https://doi.org/10.1038/modpathol.2011.45. Accessibility the ENT DR was lovely. 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. Oral Surg Oral Med Oral Pathol Oral Radiol. ENT manifestations of gastroesophageal reflux. Primary non-Hodgkin lymphoma of the tongue base: the clinicopathology of seven cases and evaluation of HPV and EBV status. [1] The growth is termed hyperplasia which may result in enlargement of various tissue including an organ, or cause a cutaneous lesion. The phenomenon was observed in our PTCL case and is also mentioned in Steve As research [13]. 2007;86:35660. Under the microscope, normal tissue was replaced by diffuse large atypical lymphocytes with relatively abundant cytoplasm. Pathobiology. Before Uherova P, Ross CW, Finn WG, Singleton TP, Kansal R, Schnitzer B. Hi, my biopsy says reactive lymphoid hyperplasia, does it means it is benign? Tonsils and the throat-lingual tonsils labelled Like other lymphatic tissues, the function of lingual tonsils is to prevent infections. a. MRI showed a mass in the base of the tongue sticking to the pharyngeal cavity and making it obviously narrow. In the literature, the patients with peripheral T cell lymphoma of the tongue base were middle aged with no obvious differences in gender distribution. Federal government websites often end in .gov or .mil. Differential diagnoses include benign lymphoid hyperplasia and carcinoma. Lymphomas of the head and neck: CT findings at initial presentation. Four were staged at III and IV and had higher IPI scores (2 or 3). 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