Feinberg SM, Ou SH, Gu M, Shibuya TY. This site needs JavaScript to work properly. Follicular lymphoid hyperplasia (FLH) is a benign lymphoproliferative process of unknown etiology, uncommon in the head and neck region. Int J Cancer. A 64-year-old African Canadian female with a history of urinary incontinence was admitted for an elective bladder suspension procedure by the gynaecology service in our institution. When on the surface tissue, there may be a yellow, white, or even vesicular appearance, as seen in Figure 1. This is consistent with head and neck research findings [6, 26]. Doctors typically provide answers within 24 hours. PMC Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. 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). 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. 2009 Mar-Apr;75(2):195-9. doi: 10.1016/s1808-8694(15)30778-3. Bone marrow biopsy is necessary to rule out CNS involvement. https://doi.org/10.1111/aos.12189. Manage cookies/Do not sell my data we use in the preference centre. Only one widely disseminated case has been referenced, which involved cervical nodes, major salivary glands, orbits, and mediastinum [4]. b. H&E showed immunoblastic large cells with an obvious nucleolus (200 x). As always, continue to ask good questions and listen to what your patients are telling you! 2017;30:S4453. In the literature, findings of RLH are well-documented. Figure 2 shows the process of a reactive lymphoid lesion histologically. Work-up of globus: assessing the benefits of neck ultrasound and videofluorography. Lopez-Guillermo et al. Lymphoid hyperplasia of the tongue is a very rare benign lymphoproliferative lesion that closely resembles carcinoma or lymphoma, clinically or histopathologically. Zhiyong Liang or Beverly Wang. The https:// ensures that you are connecting to the These cells are designed to fight. Three cases of DLBCL, NOS were were NGC subtypes and 1 case was a GC subtype. Takahashi H, Fujita S, Okabe H, Tsuda N, Tezuka F. Immunophenotypic analysis of extranodal non-Hodgkin's lymphomas in the oral cavity. 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. Am J Gastroenterol. Three reactive samples, either tonsils or lymph nodes, were included to establish cut-off values. Radiol Clin North Am. Seven cases were identified from the Pathological Registry Database at Peking Union Medical College Hospital (PUMCH). Part of [27]; of the 17 cases, 16 cases were located at the base of tongue and 14 cases were DLBCL, NOS. 2006;30:85967. f. Tumour cells were negative for CD8 (200x). Expression and alteration of p16 in diffuse large B cell lymphoma. Cancer. 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. Epub 2016 Sep 17. Then he looked down my throat through my nose. The tumour cells were large and blastic, with a high mitotic rate, which was similar to diffuse large B lymphoma tumour cells. PTCL, NOS occurring at the base of the tongue are rare. However, HPV infections have been identified with increasing frequency in patients with oropharyngeal squamous cell carcinoma, which is a predisposing risk factor [29]. Non-Hodgkins lymphoma (NHL) primarily derived from the base of the tongue, is rare. Otolaryngol Head Neck Surg. Clinical and laboratory investigations are routinely negative [2]. [7]. and transmitted securely. Case report: A 53-year-old female presented with globus sensation, mild dysphagia, nocturnal breathing problems and 'hot potato voice' dysphonia. Methods We reported a severe case of tongue base BLH compromising the breathing and swallowing of the affected patient. e. Tumour cells were positive for CD4 (200x). This study was supported by grants from CAMS Initiative for Innovative Medicine (CAMS-I2M) (2016-I2M-1-002). Bone marrow involvement was identified at relapse. [2] Lymph node anatomy [ edit] She was awarded the Dental Professional of the Year in 2017 through the International Pemphigus and Pemphigoid Foundation and is a 2017 Sunstar/RDH Award of Distinction recipient. 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. In summary, NHLs in the base of the tongue are rare with nonspecific symptoms of oropharyngeal discomfort, and they could present with normal-like mucosal surfaces. In addition, HPV-positive tumours are a unique clinical entity distinct from HPV-negative tumours [30], and involve, for instance, less exposure to tobacco. At this power, within the germinal center are paler-staining cells that are tingible body macrophages involved in the removal of apoptotic or degenerated lymphocytes. Dr. Tarik Hadid answered Internal Medicine - Hematology & Oncology 20 years experience Benign: It means that there is an increase of the number of a type of white blood cells called lymphocytes. There were two main cytomorphological variants of the DLBCL, NOS cases: centroblastic and immunoblastic. Am J Clin Pathol. official website and that any information you provide is encrypted Narla S, Annapurneswari S, Parameswaran A, Nair S. Peripheral T-cell lymphoma of tongue: Report of a rare case and review of literature. 1),and two cases expressed c-Myc(>40%). https://doi.org/10.1038/modpathol.2016.152. 2014;10:94550. Yuen A, Jacobs C. Lymphomas of the head and neck. Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry using a tissue microarray. b. Tumour cells diffusely expressed CD20 (200 x). CAS 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. 2005;9:34050. The case of DLBCL showing HPV DNA positivity (case 6). a. CT showed an irregular soft tissue mass at the right posterior aspect of the tongue base. 2000;113:5128. However, HCV infection did not have a significant impact on the overall survival or event-free survival of DLBCL patients [31].HPV infection developing in this site might be due to low immunity from B cell lymphoma or HPV contributing to the development of lymphoma. It is caused by an abnormal proliferation of secondary follicles and occurs principally in the cortex without broaching the lymph node capsule. CAS Among our cases, there were 1 GC and 3 NGC cases. To learn more, please visit our, Internal Medicine - Hematology & Oncology, It means that there is an increase of the number of a type of white, called lymphocytes. Videofluorography swallow study of patients with systemic sclerosis. Our HPV-infected patient indeed had a favourable prognosis, and he was alive and free of disease when this manuscript was prepared (68months). There were no c-Myc rearrangements, so there were no double or triple hit B cell lymphomas in these cases (Table3). 2013;119:18327. Non-Hodgkin's lymphoma of the head and neck: a 30-year experience at the University of Florida. The follicles are cytologically polymorphous, are often polarized, and vary in size and shape. Three patients are alive with disease and 2 are alive without disease. Google Scholar. Ear Nose Throat J. Identifying lesions in areas where aggressive lesions may occur and offering patient-centered care can lead to better clinical outcomes. Owosho AA, Bilodeau EA, Surti U, Craig FE. Two pathologists interpreted the FISH results using an Olympus fluorescence microscope equipped with 100 objective lens and orange/ green/4, 6-diamid-ino-2-phenylindole filters. Only one patient died of the disease. Acta Oncol. volume15, Articlenumber:30 (2020) 2010;39:86972. Another reason might be HPV is not transcriptionally active in this patient; the virus integrated into the host DNA and remained inactive. 88, no. Nuclei were counterstained with hematoxylin. Reported cases involve the conjunctiva, liver, gastrointestinal tract, stomach, lungs, paranasal sinuses, and many cutaneous areas. The population of the compartment is cytologically polymorphous. A woman in her fourth decade was admitted with a one-month history of pharyngeal foreign body sensation. It provides context as to what an oral pathologist might see that aides in excludingnonreactive or neoplastic lesions. It tends to present as a unilateral, painless, slow-growing, nonulcerated mass. The biopsy showed recurrence, with bone marrow involvement. Pictorial review: principles of double-contrast pharyngography. One of the DLBCL cases was positive for HPV DNA and diffusely expressed P16 protein. Hi, my biopsy says reactive lymphoid hyperplasia, does it means it is benign? c. Tumour cell infiltrated squamous epithelium (400x). 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. Lymphoma is the second most common primary malignancy occurring in the head and neck behind squamous cell carcinoma, while NHL accounts for 6590% of all lymphomas occurring in the head and neck [1, 2] .2030% of NHLs are derived from extra-nodal sites [3] .Nonetheless, NHL with a primary site in the oral cavity is rare, and in the tongue base, even rarer [4, 5]. 1999;26:33845. Am J Dermatopathol. Rinsho Ketsueki. Singh T, Amirtham U, Satheesh CT, Sajeevan KV, Jain A, Lakshmaiah KC, Babu KG, Lokanatha D. Primary B cell non-Hodgkin's lymphoma of tongue. Others theorize that it is caused by compensatory lymphoid hyperplasia after an adenotonsillectomy.19,20 Hypertrophied lymphoid follicles in the lingual tonsils of adults has been previously associated with the signs and symptoms of GERD.10 Mamede et al9 have suggested a possible link between the hypertrophy of the base of tongue and . Google Scholar. 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. 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. 1991;6(3):170-8. doi: 10.1007/BF02493520. Bookshelf 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]. The https:// ensures that you are connecting to the Provided by the Springer Nature SharedIt content-sharing initiative. Disclaimer. Most DLBCL cases of the tongue base had no Bcl-2, Bcl-6, or c-Myc rearrangement and they were sensitive to rituximab. We thank Violette Ghali, Gina Elhammady, Mark Persky and Songyang Yuan for confirming the pathological diagnosis. 2013;91 Thesis 5:127. Of the 6 B-cell NHL cases, 5 were DLBCLs and 1 was MCL. Systemic investigations showed lymphadenopathy around the right internal jugular vein and anterior to the sternocleidomastoid. All rights reserved. Vocal cord involvement can cause choking. Get answers from Oncologist and Hematologists and top U.S. doctors, Our doctors evaluate, diagnose, prescribe, order lab tests, and recommend follow-up care. government site. https://doi.org/10.1093/annonc/mdl131. 4, pp. https://doi.org/10.1186/s13000-020-00936-w, DOI: https://doi.org/10.1186/s13000-020-00936-w. Hypermethylation of CpG islands in p16 as a prognostic factor for diffuse large B-cell lymphoma in a high-risk group. His IPI score was 2(low to intermediate risk group). or a reactive lymphoid proliferation to an unknown antigenic stimulation [2]. [3] Follicular hyperplasia must be distinguished from follicular lymphoma (bcl-2 protein is expressed in neoplastic follicles, but not reactive follicles). Tumours in this site are predominantly DLBCL subtypes in histology. 2008;88:2068. A mass was identified in the right base of the tongue that caused breathing difficulties. Clipboard, Search History, and several other advanced features are temporarily unavailable. the ENT DR was lovely. 5760, 1993. Expression of c-Myc and p53 correlates with clinical outcome in diffuse large B-cell lymphomas. Int J Hematol. MeSH Human papillomavirus (HPV) and Epstein-Barr virus (EBV) are important aetiological risk factors for tumours of the head and neck. The base of tongue refers to the back one-third of the tongue that continues down the throat. Bookshelf Xinyu Ren and Yin Cheng contributed equally to this work. St. Louis, MO: Elsevier; 2016. An official website of the United States government. 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. Positive staining was indicated by brown punctate dots in the cytoplasm. https://doi.org/10.1053/ajot.2000.8382. Peripheral T-cell lymphoma mimicking marginal zone B-cell lymphoma. Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. 2009 Sep;114(6):948-59. doi: 10.1007/s11547-009-0416-4. The data used and/or analysed during the current study are available from the corresponding author on reasonable request. 7th ed. 2, pp. Lymphoid hyperplasia of the tongue is a very rare benign lymphoproliferative lesion that closely resembles carcinoma or lymphoma, clinically or histopathologically. 4th ed. https://doi.org/10.2214/ajr.149.3.575. 2012;87:6049. 7982, 2009. .. J Laryngol Otol. 2006;17:143440. Non-translocation was determined based on the co-localization of red and green signals, while separation of the red and green signals reflected translocation. Acta Ophthalmol. XS and QL did the HPV ISH. All 7 lymphomas were localized at the base of the tongue. The tumour cell composition of MCL varies greatly in the literature, from small cells with slightly irregular nuclei to large cells similar to the large cells in DLBCL, which could be misdiagnosed as DLBCL. Asian Pac J Cancer Prev. Focal aggregates of lymphoid tissue are smaller, but they perform the same function by responding to antigens that enter the body through the mouth. When oral aggregates appear in clusters or have an unusual appearance or enlargement, clinicians may question whether abnormalities are present. Maheshwari GK, Baboo HA, Gopal U, Wadhwa MK. What are the symptoms and prognosis for a benign reactive lymphoid hyperplasia of the neck lymph node? 2010;77:96105. HPV is considered to be associated with the occurrence of oropharyngeal squamous cell carcinoma [8], therefore, we detected the infection status of the the two viruses in lymphoma of the base of the tongue. 1997;36:41320. 2, no. The other two cases were mantle cell lymphoma (MCL) and peripheral T cell lymphoma, not otherwise specified (PTCL, NOS). Sirsath NT, Lakshmaiah KC, Das U, Lokanatha D, Chennagiri SP, Ramarao C. Primary extranodal non-Hodgkin's lymphoma of oral cavity--a single Centre retrospective study. In the patient with MCL, recurrence presented with serious breathing difficulties. Correspondence to 172175, 2003. Cases of PTCL and MCL are described in detail in the Results section. Ren, X., Cheng, Y., Wu, S. et al. Copyright 2011 Noah B. Sands and Marc Tewfik. Imaging and pathological findings of PTCL (case 3). f. Ki-67 staining of the tumour cells (200x). The patient received two cycles of GDP (gemcitabine, dexamethasone, cisplatin) and seven cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy. doi: 10.1148/radiology.144.4.7111732. 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. All 7 lymphomas were localized at the base of the tongue. 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. 2012;28:43541. Effect of gastroesophageal reflux on hypertrophy of the base of the tongue. Sun J, Zhang J, Ling Q, Luo Y, Wu S, Liang Z, Zhong D, Zeng X. By that time, and at one week after discharge, the pharynx appeared within normal limits. 144, No. May SA, Jones D, Medeiros LJ, Duvic M, Prieto VG, Lazar AJ. Almost all cancers in the base of the tongue are squamous cell carcinomas, which form in the thin, flat cells that line the larynx. 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. We not only report on the general clinicopathological features, including age, gender, tumour location, histological subtypes, grading and staging, but also provide important information related to prognosis and treatment. Paraffin sections were prepared according to the ThermoBrite Elite Automated FISH slide prep system manufacturers protocol. Here we present a literature review and case series of seven patients with NHL of the tongue base. Please enable it to take advantage of the complete set of features! Lymphoid hyperplasia at the base of the tongue. 96, no. On this Wikipedia the language links are at the top of the page across from the article title. 3840, 1973. The remaining five patients were alive through the end of follow up. Federal government websites often end in .gov or .mil. Abstract Background Benign lymphoid hyperplasia (BLH) is a benign proliferation of lymphoid tissue in response to external irritation. This entity was first described in 1973 by Adkins. Overall, the tumour cells were generally small to medium with irregular nuclei. 1970 Dec;8(3):413-24. Springer Nature.

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