September 30, 2006 Adenike F. Oluwasanmi, FRCS; Stephen J. Wood, FRCS; David L. Baldwin, FRCS; Fabian Sipaul, MRCS
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Abstract
An abnormally large tonsil may be a sign of malignancy. We retrospectively analyzed the case files of 87 patients who had asymmetrically sized but otherwise normal tonsils and no risk factors for cancer to determine if asymmetry is associated with a higher incidence of malignancy. We found 2 cases (2.3%) of malignancy among these patients. One patient had high-grade non-Hodgkin's lymphoma in the larger tonsil, and the other had lymphocyte-rich Hodgkin's lymphoma. Both patients were older than 50 years, and neither had a history of recurrent tonsillitis. We believe that although the incidence of cancer in our series was small, it is significant. Therefore, we recommend routine excision of abnormally large tonsils. Moreover, when making such a recommendation to a patient, it is essential that the patient have a clear understanding of the risk and benefit of having a tonsil removed solely because of asymmetry.
September 30, 2006 Liron Pantanowitz, MD; Lester D.R. Thompson, MD, FASCP
August 31, 2006 Sheldon P. Hersh, MD; Winston G. Harrison, MD; David J. Hersh, MD
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Abstract
Temporal bone lymphomas are rare and typically metastatic neoplasms. We describe a case of primary B cell lymphoma that originated in the external auditory canal of an elderly woman. The diagnosis was based on histopathologic examination supplemented by immunophenotypic analysis. The patient was treated with external-beam radiation and remained disease-free throughout 9 years of follow-up. We also point out that the presence of non-Hodgkin's lymphoma in an unusual site may be an indication that the patient has an acquired immunodeficiency syndrome.
April 30, 2006 M. Panduranga Kamath, MS; Gurudath Kamath, MS; Kiran Bhojwani, MS; Mukhta Pai, MD; Ahamed Shameem, MBBS; Salil Agarwal, MBBS
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Abstract
Sinonasal lymphomas are uncommon malignancies. They are difficult to differentiate from carcinomas, and immunohistochemistry is needed to make the diagnosis. We describe an unusual case of a T cell lymphoma that involved only the paranasal sinuses in a middle-aged man. The patient presented with a complete loss of vision in one eye and lateral rectus muscle palsy, but no nasal symptoms.
February 1, 2006 Ronnie Word, MD; Andrew C. Urquhart, MD; Victor S. Ejercito, MD
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Abstract
Extranodal laryngeal lymphoma is extremely rare. We report a case of primary laryngeal lymphoma in a 76-year-old man who had presented with a 7-week history of progressive hoarseness. Laryngoscopy revealed asymmetry of the right false vocal fold. Pathology of a deep biopsy specimen identified a malignant, diffuse, CD20-positive, B-cell lymphoma. The stage 1E lymphoma completely resolved after treatment with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) and rituximab. Despite its relative rarity, the consequences of a missed diagnosis warrant vigilance for this type of laryngeal tumor.
February 1, 2006 Evan R. Reiter, MD; Michael O. Idowu, MD; Celeste N. Powers, MD, PhD
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Abstract
Most paratracheal masses are of thyroid origin. We describe two cases of vocal fold paralysis that were caused by unusual paratracheal masses. In one case, a 35-year-old man was found to have a malignant lymphoma that originated in the mediastinum and extended above the clavicle. The other patient was a 53-year-old man with an enlarged left thyroid lobe, tumor invasion of the adjacent larynx and trachea, and multiple pulmonary nodules all due to adenoid cystic carcinoma. Unusual paratracheal masses presenting with vocal fold paralysis may mimic thyroid malignancies, thereby posing both diagnostic and therapeutic challenges. Fine-needle aspiration cytology is often helpful in making a definitive diagnosis, but incisional biopsy is necessary in some cases.
April 1, 2005 Andres Eraso, MD; Giovanni Lorusso, MD; Enrique Palacios, MD, FACR
January 1, 2005 Maura C. Neves, MD; Marcus M. Lessa, MD, PhD; Richard L. Voegels, MD, PhD; Ossamu Butugan, MD, PhD
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Abstract
Non-Hodgkin's lymphoma of the sinonasal tract is an uncommon lesion, representing 1.5 to 15% of all lymphomas. Most cases of primary non-Hodgkin's lymphoma of the sinonasal tract occur in the maxillary sinus, ethmoid sinus, and nasal cavity; its occurrence in the frontal sinus is extremely rare. We report a case of primary type B non-Hodgkin's lymphoma of the frontal sinus in a 43-year-old man. The patient complained of frontal headaches that had not improved with analgesic drugs, and he presented with a frontal bulge that involved the left upper eyelid; the bulge had progressively enlarged over a 3-month period. A biopsy of the mass identified the type B non-Hodgkin's lymphoma. Immunohistochemical study not only confirmed the histologic type of the tumor, it also provided some important information about the primary tumor site. Advances in immunohistochemistry have shown that type B non-Hodgkin's lymphoma is more common in North American and European patients, whereas subtype T is more common in Asians and in some Latin Americans. The treatment of this condition is still controversial, but the combination of radiotherapy and chemotherapy has yielded the best results in all stages of the disease.
December 1, 2004 Jonathan W. Hafner, BS; Thomas H. Costello, MD; Rose Mary S. Stocks, MD, PharmD; Fadi Ibrahim, MD;
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Abstract
Childhood primary parotid non-Hodgkin's lymphoma (NHL) is a rare but well-recognized entity in the literature. Perineural extension of masses between the head and neck and cranium, although rare, has also been well documented. We report the first documented case, to our knowledge, of a left-sided primary parotid NHL in a child with direct intracranial extension through the foramen rotundum. The mass arose in a 1½-month period. Following evaluation by computed tomography and magnetic resonance imaging, diagnostic procedures (first, fine-needle aspiration and, subsequently, an open biopsy) were undertaken. We discuss the case report and briefly review childhood NHL and perineural metastasis.
April 30, 2004 Haig Tcheurekdjian, MD; Oliver Jenkins, MD; Robert Hostoffer, DO
