Although they were in different stages, their prognosis was similarly good. Under the microscope, normal tissue was replaced by diffuse large atypical lymphocytes with relatively abundant cytoplasm. 4, pp. Epub 2016 Sep 17. Article Lymphoid hyperplasia at the base of the tongue. Burkitt's lymphoma of the base of the tongue: a case report and review of the literature. Shiozawa E, Takimoto M, Makino R, Adachi D, Saito B, Yamochi-Onizuka T, Yamochi T, Shimozuma J, Maeda T, Kohno Y, Kawakami K, Nakamaki T, Tomoyasu S, et al. Synchronous cancers in patients with head and neck cancer: risks in the era of human papillomavirus-associated oropharyngeal cancer. Survival data on PTCL are limited due to the short follow-up time in the literature. An official website of the United States government. This entity was first described in 1973 by Adkins. The biopsy showed recurrence, with bone marrow involvement. Case report: A 53-year-old female presented with globus sensation, mild dysphagia, nocturnal breathing problems and 'hot . 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. Image courtesy of James J. Sciubba, DMD, PhD. Viral infections, such as HIV or hepatitis C virus (HCV), can also develop in immunocompromised patients. 2015;390:31537. Unauthorized use of these marks is strictly prohibited. 2017;118:6028. 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. This report adds valuable knowledge to the possible virus infection status of tongue NHL, due to its rare occurrence. https://doi.org/10.1038/modpathol.2016.152. Nancy W. Burkhart, EdD, BSDH, AFAAOM, is an adjunct associate professor in the Department of Periodontics-Stomatology, College of Dentistry, Texas A&M University, Dallas, Texas. The population of the compartment is cytologically polymorphous. St. Louis, MO: Elsevier; 2017. The outer cortex is composed of follicles of B cells so that it is called the B-cell zone. A minority of patients develop local recurrence. 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. One case presented as multiple deep ulcers. The follow-up period started from the date of diagnosis until August 30, 2019, and ranged from 3 to 90months. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Common symptoms reported by people with benign lymphoid hyperplasia Common symptoms How bad it is What people are taking for it Fatigue Handicap/Disability Parking Permit Pain 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. Squamous cell hyperplasia in the oral cavity is seen most commonly on the tongue, palate, and lateral wall of the pharynx. Bookshelf Although it had been described in the literature, occurrence within oral cavity is rare. Written informed consent was obtained from each patient. ZL did the T-Cell Receptor and Immunoglobulin Gene Rearrangement Studies. https://doi.org/10.2214/ajr.149.3.575. https://doi.org/10.1017/s0022215100142288. sharing sensitive information, make sure youre on a federal 8600 Rockville Pike https://doi.org/10.1016/j.anndiagpath.2005.09.020. Aguilera NS, Uusafr M, Wenig BM, Abbondanzo SL. 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. Her IPI score was 3 (high risk group). Lymphoid hyperplasia of the tongue is a very rare benign lymphoproliferative lesion that closely resembles carcinoma or lymphoma, clinically or histopathologically. Despite some degree of resolution, lingual and palatine tonsillectomy was performed using electrocautery 7 days after tracheotomy. An abstract is unavailable. National Library of Medicine Extranodal lymphomas of the head and neck. Leuk Res. 2010;47:846. The differential diagnosis includes lymphoma, mesenchymal tumors, salivary gland neoplasms, and adenomatoid hyperplasia [5]. 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. Vocal cord involvement can cause choking. Understanding the biological behavior of and therapeutic options for tongue lymphoma is difficult due to the paucity of cases. Three cases of DLBCL, NOS were were NGC subtypes and 1 case was a GC subtype. There were two main cytomorphological variants of the DLBCL, NOS cases: centroblastic and immunoblastic. Four out of five of the DLBCL cases were NOS subtypes. With proper therapy, even late stage tongue base lymphomas can be suppressed and remain in remission. Acta Oncol. PET-CT/CT/MRI scans of the cancerous areas were reviewed to assess the extension of the lesions, including to the bone and thorax. Saxman S, Righi P. Mantle cell lymphoma appearing as a tongue base mass. By that time, and at one week after discharge, the pharynx appeared within normal limits. Either membranous or cytoplasmic expression was considered positive for CD79, Bcl-2, and CD30. 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. Six of the cases exhibited tongue base masses with smooth surface membranes. All patients were diagnosed by either biopsy or tumor resection. Feinberg SM, Ou SH, Gu M, Shibuya TY. government site. An official website of the United States government. Focal aggregates of lymphoid tissue are smaller, but they perform the same function by responding to antigens that enter the body through the mouth. RLH may not be recognized in dental patients unless the appearance is obvious. Uherova P, Ross CW, Finn WG, Singleton TP, Kansal R, Schnitzer B. Otolaryngol Head Neck Surg. Oral Pathology: Clinical Pathologic Correlations. 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. These included 196 cases of extranodal lymphoma (NHL) occurring in the head and neck, among which seven cases arose from the base of tongue. The remaining five patients were alive through the end of follow up. official website and that any information you provide is encrypted The aetiological factors for lymphoma of the oral region other than EBV and HIV are little known. Results came back "lymphoid hyperplasia". 2, pp. 18, no. official website and that any information you provide is encrypted 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. Microorganisms that are regularly associated with the development of NHL include EBV, HIV,etc. In the middle power view, there were plenty of moderate to large cells with distorted nuclear contours (Fig. 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. Int J Oral Maxillofac Surg. 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. b. H&E showed moderate to large cells with distorted nuclear contours (200 x). [1] The growth is termed hyperplasia which may result in enlargement of various tissue including an organ, or cause a cutaneous lesion. Cookies policy. The mean size is 2.5cm in the literature (range 15cm). All 7 lymphomas were localized at the base of the tongue. ENT manifestations of gastroesophageal reflux. The DLBCL, NOS cases were further divided into GC and NGC B cell like subtypes based on immunohistochemical expression of CD10, Bcl-6 and Mum1 [11]. All rights reserved. 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. B. C. Jham, N. O. Binmadi, M. A. Scheper et al., Follicular lymphoid hyperplasia of the palate: case report and literature review, Journal of Cranio-Maxillofacial Surgery, vol. Lee JT, Paquette R, Sercarz JA, Wang MB. a. CT showed a well-bordered cystic mass. 2005;29:128493. 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. 2012;87:6049. 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]. Lymphoid hyperplasia is not a disease or a tumor, but simply a term we use to represent enlarged tissue masses. 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. 2023 Endeavor Business Media, LLC. 3840, 1973. 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. The appearance of brown punctate dots in the tumour cell nucleus or cytoplasm was considered positive. Cut-off values were set as previously described [9]. The most common histologic subtype was diffuse large B-cell lymphoma (DLBCL), which occurred in five cases. 2005;9:34050. 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. PubMedGoogle Scholar. The role of EBV in the pathogenesis of diffuse large B cell lymphoma. 353358, 2001. Get answers from Oncologist and Hematologists and top U.S. doctors, Our doctors evaluate, diagnose, prescribe, order lab tests, and recommend follow-up care. As they mount an immune response, lymphoid cells can proliferate and enlarge. Immunohistochemically, the atypical lymphoid cells were positive for CD20, CD79a, PAX-5, CD5, CyclinD1 protein, and Ki-67 antigen (labelling 25%). Roentgen examination of the oropharynx and oral cavity. 1970 Dec;8(3):413-24. 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. 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. This is because reactive growth of lymphoid tissue can be difficult to distinguish from the most serious neoplastic lesions.1. Lopez-Guillermo et al. Lee YY, Van Tassel P, Nauert C, North LB, Jing BS. As always, continue to ask good questions and listen to what your patients are telling you! Immunohistochemistry was negative for lymphoma. 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. From: The Teaching Files: Chest, 2010 View all Topics I have a swollen neck, the reports tell that I've got reactive Lymphoid Hyperplasia. 2014;118:33847. In addition, an understanding of these diseases will allow the development of new targeted therapies for these aggressive lymphomas. While an association with bacterial infection has not been clearly identified, one aggressive case of FLH has been linked to the presence of Epstein-Barr virus, causing clonal arrangement (expansion) in the local tissue DNA [4]. The prognosis for MCL seems to be poorer than that for DLBCL at the base of the tongue. PubMed volume15, Articlenumber:30 (2020) Squamous cell hyperplasia is characterized by increased cell numbers, which usually results in increased thickness of the squamous epithelium. Imaging and pathological findings of PTCL (case 3). 2000;46:2112. D. L. Harsany, J. Ross, and W. E. Fee, Follicular lymphoid hyperplasia of the hard palate simulating lymphoma, OtolaryngologyHead and Neck Surgery, vol. Pathol Res Pract. [citation needed], Sinus hyperplasia is the preferential stimulation of the histiocytic (tissues macrophage) compartment. Clinicopathological information including age, gender, tumour location, histological subtype, grading, staging, survival, and response to treatment was acquired from the archives. Unable to load your collection due to an error, Unable to load your delegates due to an error. The site is secure. [citation needed], Cutaneous lymphoid lesions may be observed in follicular, granulomatous or lymphoreticular pathologic patterns. 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. One of the DLBCL cases was positive for HPV DNA and diffusely expressed P16 protein. Surgical debulking/excision is the treatment of choice. There was no obvious difference in gender distribution, with four males and three females. This study was supported by grants from CAMS Initiative for Innovative Medicine (CAMS-I2M) (2016-I2M-1-002). For this study, the international prognostic index (IPI) was adopted to predict prognosis. 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. World J Gastroenterol. 2014;3:731. https://doi.org/10.1186/2193-1801-3-731. 2. the ENT DR was lovely. 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. Most of these cancers are squamous cell carcinoma and caused by human papillomavirus (HPV) infection. Pictorial review: principles of double-contrast pharyngography. This is slightly different from the cases reported by Owosho AA et al. Globus pharyngeus: a review of its etiology, diagnosis and treatment. [7]. Two patients, including our patient, died during follow-up. Owosho AA, Bilodeau EA, Surti U, Craig FE. Terms and Conditions, Reported cases involve the conjunctiva, liver, gastrointestinal tract, stomach, lungs, paranasal sinuses, and many cutaneous areas. Int J Cancer. 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. 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. CAS Domanski HA, Akerman M. Fine-needle aspiration cytology of tongue swellings: a study of 75 cases. https://doi.org/10.1200/JCO.2005.07.155. All 7 lymphomas were localized at the base of the tongue. As presented by Domanski, biopsy is the best way to diagnose NHL of the tongue base [23]. When we think of hyperplasia, we think of excessive tissue growth. Patricia Uherova et al. Squamous cells also make up the top layer of skin and other body parts such as the lungs and esophagus. 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. https://doi.org/10.1007/978-3-319-22822-8_13. LH most commonly affects older patients, with a mean age of 61 and female-to-male ratio of nearly 3:1. The most common symptoms are varying degrees of discomfort in the pharynx, such as the sensation of a foreign body or choking while drinking. It provides context as to what an oral pathologist might see that aides in excludingnonreactive or neoplastic lesions. She can be contacted at nburkhart@tamhsc.edu. For T cell receptor rearrangement, the IdentiClone TCRB, TCRG, and TCRD Gene Clonality Assays were used with gel detection (InVivoScribe Technologies, San Diego, CA, USA). showed that 74% of DLBCL cases have P16 methylation and a relatively old age [32]. 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]. HIV serology was negative. Cancer that develops in the base of the tongue is a type of head and neck cancer. 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. e. Tumour cells were positive for P53 (200 x). 1997;76:356. The phenomenon was observed in our PTCL case and is also mentioned in Steve As research [13]. Cytoplasmic composition also varied between cases, from abundant to scant. Accessibility This is an open access article distributed under the. he started bty saying 90% of urgent referrals were viral so should be fine. They are covered by stratified squamous nonkeratinized epithelium and contain deep crypts and mucosal glands. Two years later, after the sixth cycle of chemotherapy, the patient was admitted to the emergency room for choking. Connect with a U.S. board-certified doctor by text or video anytime, anywhere. e. Tumour cells were positive for CD4 (200x). The biological behaviours that are exclusive to the tongue base are not clear. Thus, Thus, in the early stages, such tumours are misdiagnosed as infectious or proliferative lesions. Regezi JA, Sciubba JJ, Jordan RCK. In the literature, findings of RLH are well-documented. and has since been primarily reported in the skin, breasts, gastrointestinal tract, lungs, and nasopharynx [2]. Mamede RC, Amaral Fd, Raimundo DG, Freitas LC, Ricz HM, Mello Filho FV. 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. Curr Allergy Asthma Rep. 2008 May;8(3):240-4. doi: 10.1007/s11882-008-0040-8. 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. sharing sensitive information, make sure youre on a federal 2006;30:85967. d. Tumour cells were positive for CD5 (200x). This may have been due to the expression of the cytotoxic marker TIA, Granzyme B, and a much higher Ki-67 index (80%), which may indicate a poor prognosis [41]. 2011;24:98392. Indian J Cancer. Reference Sands and Tewfik 1 The aetiology is poorly understood, . 2017;58:203342. The majority of existing head and neck reports are of hyperplasia in the oral cavity, namely, of the mucosa overlying the hard palate, and are limited to the dental and pathology literature [3]. What are chaces of malignancy?What precautions for future shud i take? Baran M, Canoz O, Altuntas H, Sivgin S, Cetin M, Yay A, Ketenci S. Immunohistochemical investigation of P16, P53 and Ki-67's prognostic values in diffuse large B-cell lymphomas. The lingual tonsil is located at the base of the tongue and related to circumvallate papillae, whereas subepithelial lymphoid tissue at the posterior lateral portion of the tongue and related to foliate papillae constitutes the lateral lingual tonsil. Vose JM. Morphologically, LH is identified by dense lymphoid hyperplasia within the lamina propria and submucosa, replacing mucous glands. Of the 6 B-cell NHL cases, 5 were DLBCLs and 1 was MCL. Ekstrom-Smedby K. Epidemiology and etiology of non-Hodgkin lymphoma--a review. e. Tumour cells were positive for Cyclin D1 (200x). Article 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. In the throat, at the base of the tongue, where tongue cancer may develop with few signs and symptoms (hypopharyngeal tongue cancer). Clipboard, Search History, and several other advanced features are temporarily unavailable. 1, pp. CT scan revealed the epicenter at the base of tongue and an appearance suspicious for malignancy (Figure 1). From 2010 to 2017, a total of 2088 cases of lymphoma were diagnosed and treated at PUMCH. Mamede RC, De Mello-Filho FV, Vigrio LC, Dantas RO. Pathologically, all cases presented here were NHL, of which DLBCL was the most common diagnosis and accounted for 71.4% of the patients. Maheshwari GK, Baboo HA, Gopal U, Wadhwa MK. A man in his fourth decade was admitted with pharyngeal foreign body sensation for two months.

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