Lymphoma

MALT lymphoma

October 31, 2010     Kristin K. Marcum, MD, E. Shannon Kemp, CCC-SLP, and Catherine J. Rees, MD
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Subglottic lymphoma

August 31, 2010     David O. Francis, MD and Albert L. Merati, MD
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Diffuse large B-cell lymphoma of the maxillary sinus

May 31, 2010     Ryan M. O'Connor, MD, Matthew Vasey, MD, and Jonathan C. Smith, MD, FACS
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Abstract

We report the case of a 25-year-old man with a history of recent facial trauma who presented with a mildly painful swelling of the left maxilla and nasal obstruction. The patient was initially diagnosed with left maxillary sinus osteomyelitis secondary to undiagnosed and untreated left maxillary sinus fractures. However, further evaluation revealed that the patient had diffuse large B-cell lymphoma.

Non-Hodgkin lymphoma presenting as bilateral tonsillar hypertrophy: Case report

March 31, 2010     Sardar U. Khan, DLO, FCPS, FRCS(Ire), Cyril Kenefick, FRCS, FRCS(Edin), Gerard O'Leary, FRCS(Edin), FRCS(Ire), and James J. Lucey, FRCPath
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Abstract

We describe the case of a 57-year-old man who was referred to us with persistent sore throat, dysphagia, and enlarged tonsils. He had not responded to earlier treatment with antibiotic therapy and other routine measures. In view of the persistent nature of the patient's symptoms and the tonsillar hypertrophy, we decided to perform a tonsillectomy and to send the excised specimens for pathologic analysis. Histologic evaluation identified non-Hodgkin lymphoma in both tonsils. The patient was treated with postoperative chemo- and radiotherapy, and he was free of symptoms during 18 months of follow-up. To the best of our knowledge, only 4 cases of bilateral non-Hodgkin lymphoma of the tonsils have been reported in the English-language literature. We also discuss the importance of histologic analysis of excised tonsil tissue in selected cases.

Development of a Hodgkin disease tumor in the neck of a patient who previously had undergone complete excision of a hyaline-vascular Castleman disease neck mass

March 31, 2010     Evrim E. Ünsal Tuna, MD, Cem Özbek, MD, Nilüfer Arda, MD, Evrensel Ilkdogan, MD, Hüseyin Dere, MD, and Cafer Özdem, MD
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Abstract

Castleman disease is an uncommon cause of a neck mass. A benign lymphoproliferative disorder, it may be seen as a self-limited unicentric process or as a fulminant multicentric disease with systemic symptoms. The association between Hodgkin disease and Castleman disease has been debated extensively, but this association is rare. The associated Hodgkin disease frequently has been of the interfollicular subtype and typically has coexisted with the multicentric plasma-cell variant of Castleman disease. We report a case of mixed-cellularity Hodgkin disease of the neck in a patient previously diagnosed with hyaline-vascular-type Castleman disease who had undergone complete excision of a neck mass 2 years earlier.

MALT lymphoma of the floor of the mouth: A case report

July 31, 2009     Swarupa Gadre, MD, Matthew W. Ryan, MD, and Roberto Logroño, MD
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Abstract

MALT (mucosa-associated lymphoid tissue) lymphomas are low-grade extranodal B-cell lymphomas that may involve various sites in the head and neck including the thyroid, salivary, and lacrimal glands. Development of MALT lymphoma in the head and neck is often associated with autoimmune diseases such as Sjögren syndrome or Hashimoto thyroiditis. Here we report a case of a MALT lymphoma of the floor of the mouth that likely arose in the sublingual gland. The patient was successfully treated with external-beam radiation therapy and remained disease-free at the 4-year follow-up.

Systemic lupus erythematosus in a patient with primary MALT lymphoma of the larynx

July 31, 2009     Núria Gonzàlez, MD, Blanca Xicoy, MD, Alejandro Olivé, MD, Josep Jové, MD, Josep-Maria Ribera, MD, and Evarist Feliu, MD
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Abstract

Primary lymphomas of the larynx are extremely rare. Even more unusual is their association with rheumatologic diseases. Some cases of lymphoma have developed after chemotherapy for rheumatologic diseases, suggesting that the treatment may contribute to the development of lymphoma. The converse can also occur-the development of rheumatologic disease after a primary laryngeal lymphoma-but that is even rarer. We report a case of primary extranodal marginal zone B-cell MALT (mucosa-associated lymphoid tissue)lymphoma of the larynx in a 42-year-old woman treated with involved-field radiotherapy who developed systemic lupus erythematosus (SLE) 1 year after the lymphoma diagnosis. Currently, the patient remains in remission 8 years after her diagnosis. The SLE, for which she is receiving maintenance therapy, is stable.

Potential predisposition for nasal septal perforation with methotrexate use: Report of 2 cases and literature review

July 31, 2009     Scott L. Lee, MD, David Neskey, MD, and Jason Mouzakes, MD
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Abstract

Methotrexate is a dihydrofolate reductase inhibitor with application both as a chemotherapeutic agent and as a disease-modifying antirheumatic drug. Although its ability to inhibit cellular proliferation is a desired effect in its role as an antineoplastic agent, this property may also hinder normal physiologic regeneration of the nasal epithelium. This effect may predispose patients to septal cartilage ischemia, necrosis and, eventually, perforation. We report 2 cases of septal perforations in the setting of prolonged methotrexate use and present a literature review. Patient 1 is an 8-year-old boy with juvenile rheumatoid arthritis managed with weekly methotrexate who developed a 4-mm septal perforation with an unremarkable biopsy. This was closed with a mucosal advancement flap without incident. Patient 2 is an 11-year-old boy with non-Hodgkin lymphoma treated with methotrexate. His examination was significant for a large perforation of the dorsocaudal septum. A biopsy was negative for malignancy in this patient. Repair has been deferred-initially for chemotherapy and currently for treatment relapse. We hypothesize that prolonged use of methotrexate alters the balance between physiologic desquamation and epithelial regeneration. This imbalance may promote septal ischemia and predispose patients to the development of septal perforations.

Adult Burkitt lymphoma originating in the sphenoid sinus: Case report and review of the literature

June 30, 2009     Sri Kiran Chennupati, MD, Satish Govindaraj, MD, Gavin Setzen, MD, and Alexander G. Chiu, MD
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Abstract

Burkitt lymphoma is a high-grade B-cell non-Hodgkin lymphoma. The endemic form of this malignancy occurs primarily in children aged 5 to 7 years, and it presents with jaw and facial bone involvement. The sporadic form affects older children (mean age: 12.2 yr) and often manifests as an abdominal mass; it rarely involves the head and neck. The presence of any type of lymphoma in the paranasal sinuses is rare. We report a case of Burkitt lymphoma that originated in the sphenoid sinus in a 66-year-old white woman. The patient presented with hypoesthesia in the left V1 and V2 distributions and frequent left-sided headaches. Imaging revealed that the destructive lesion had spread into the cavernous sinus and infratemporal fossa. Repeat imaging showed progression of the lesion in just 1 month. An endoscopic sphenoidotomy was performed to obtain a tissue specimen, and a diagnosis of sporadic Burkitt lymphoma was established on the basis of its clinical, morphologic, and immunohistochemical characteristics. The patient underwent chemotherapy and radiation. Short-term follow-up imaging showed that the lesion had disappeared, and the patient remained disease-free at 3 years of follow-up. This case is one of the few reported cases of true adult Burkitt lymphoma originating in the sphenoid sinus. We discuss the rapid progression of the disease and the considerable amount of invasion that can occur with minimal symptoms.

Lymphoma in the Waldeyer ring: A great masquerader

May 31, 2009     Ryan F. Osborne, MD, FACS, Jason S. Hamilton, MD, FACS, and Sofia Avitiaz, MD
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Angiogenic non-Hodgkin T/natural killer (NK)-cell lymphoma: Report of three cases

September 25, 2008     Rubens A. Martins-Filho, MD, Ricardo C. Demarco, MD, Fabiana C.P. Valera, MD, Catarina Shaletich, MD, Paulo R. Félix, MD, Giovana B. Badiale, MD, and Wilma T. Anselmo-Lima, MD, PhD
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Abstract

Angiogenic T/natural killer (NK)-cell lymphoma is a non-Hodgkin lymphoma characterized by necrosis and vascular destruction that is strongly associated with Epstein-Barr virus and AIDS. Early diagnosis is essential to improve the chances of patient survival, but severe local inflammatory infiltrate impairs histologic diagnosis by obscuring neoplastic cells. The most common markers are CD2, CD56, cytoplasmic CD3, and CD43 EBV. We describe 3 cases of angiogenic T/NK-cell lymphoma that show the diverse presentation of the same disease. Patient 1 was HIV positive and had nasal obstruction, facial edema, and ulceration of the nasal mucosa. Patient 2 had fever, a sore throat, and weight loss. Patient 3 had facial edema, fever, proptosis, and rapid development of neurologic alterations. Several biopsies were needed for histologic confirmation in these patients, despite positivity for the CD3 and CD56 markers.

Trigeminal ganglion dysfunction secondary to lymphoma

December 1, 2007     Juan Gómez, MD, Jagan Gupta, MD, and Enrique Palacios, MD, FACR
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