Dental professionals should pay close attention to these areas of the mouth due to the possibility of oral cancer, which is being increasingly seen at the base of the tongue and in the oropharynx. Clinical images of entities may be beneficial for documentation purposes, as they may be viewed during future appointments should there be recurrences. 2023 BioMed Central Ltd unless otherwise stated. https://doi.org/10.1097/01.dad.0000246949.49071.17. Non-Hodgkins lymphoma (NHL) primarily derived from the base of the tongue, is rare. Google Scholar. Extranodal NHL is complicated; it consists of a group of tumours with different pathological, clinical and prognostic characteristics [6] .Existing series presenting extranodal NHL have mainly summarized the tumours that occur in the head and neck but are not specific to the base of the tongue. The site is secure. Federal government websites often end in .gov or .mil. This is because reactive growth of lymphoid tissue can be difficult to distinguish from the most serious neoplastic lesions.1. 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. K. F. Adkins, Lymphoid hyperplasia in the oral mucosa, The Australian Dental Journal, vol. His IPI score was 2(low to intermediate risk group). A man in his fourth decade was admitted with pharyngeal foreign body sensation for two months. J Oral Maxillofac Pathol. Non-Hodgkin's lymphoma of the head and neck: a 30-year experience at the University of Florida. Imaging examination can help identify lesions. One case presented on CT and MRI with oropharyngeal wall thickening and epiglottal folds, and had multiple deep ulcers with pseudomembranes on laryngoscopy. Her IPI score was 3 (high risk group). 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. 2006;30:85967. e. HPV DNA ISH showed brown punctate dots in the tumour cell nucleus or cytoplasm (400x).f. 4 Metrics Downloaded 279 times PDF download Imaging showed a well-bordered cystic mass (2cm in diameter) at the right base of the tongue that extended into the pharynx, and so a biopsy was performed. Six of the cases exhibited tongue base masses with smooth surface membranes. It is composed of cortex and medulla. It is worth noting that tumour cells can infiltrate the squamous epithelium in this type of lymphoma. When the lymphoid tissue is deeply seated, the appearance may be more pink or deeper in color. 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. 2001;23:54758. Extranodal lymphomas of the head and neck. 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. J Clin Oncol. 2005;23:2797804. Cancer that develops in the base of the tongue is a type of head and neck cancer. Review of the preoperative anaesthesia records revealed no features of airway obstruction nor B symptoms on clinical history. a. H&E showed a diffuse infiltrate of large cells with an obvious nucleolus and abundant cytoplasm (200 x). Metastasis of the regional neck lymph nodes was noted in one case at the time of diagnoses. Chemotherapy containing rituximab was considered to significantly improve survival in DLBCL and MCL patients [39, 43]. b. PubMed 2000;21:2716. 3840, 1973. The https:// ensures that you are connecting to the a. CT showed a well-bordered cystic mass. Patient ages ranged from the thirties to the nineties, with an average age of 61.8years. SW and XZ did the BCL-2, BCL-6, c-MYC FISH examination. Methods We reported a severe case of tongue base BLH compromising the breathing and swallowing of the affected patient. Please enable it to take advantage of the complete set of features! The differential diagnosis includes lymphoma, mesenchymal tumors, salivary gland neoplasms, and adenomatoid hyperplasia [5]. Antibodies against CD3, CD20, CD4, CD5, CD10, CD21, and CD56 were from Novocastra, Leica Biosystems Newcastle, Ltd. Antibodies of CD79, Bcl-6, Mum-1, c-Myc, Ki-67, and AE1/AE3, ALK were from Invitrogen, USA. Sun J, Zhang J, Ling Q, Luo Y, Wu S, Liang Z, Zhong D, Zeng X. In special cases, several biopsies are needed. Globus pharyngeus: a review of etiology, diagnostics, and treatment. Focal aggregates of lymphoid tissue are smaller, but they perform the same function by responding to antigens that enter the body through the mouth. sharing sensitive information, make sure youre on a federal 1970 Dec;8(3):413-24. Asano N, Suzuki R, Kagami Y, Ishida F, Kitamura K, Fukutani H, Morishima Y, Takeuchi K, Nakamura S. Clinicopathologic and prognostic significance of cytotoxic molecule expression in nodal peripheral T-cell lymphoma, unspecified. 39, no. Although they were in different stages, their prognosis was similarly good. Other features include presence of white spaces and lymphocytes (large cells) within sinuses. Upon examination with direct laryngoscopy a large, multiloculated, exophytic mass was identified, emanating from the oropharynx and extending distally to the level of the supraglottis, occupying >90% of the upper aerodigestive tract. Lymphoid hyperplasia at the base of the tongue. Benign lymphoid hyperplasia is a benign proliferation of lymphoid tissue in response to external irritation and occurrence within oral cavity is rare. Lymphoid hyperplasia is not a disease or a tumor, but simply a term we use to represent enlarged tissue masses. One of the DLBCL cases was positive for HPV DNA and diffusely expressed P16 protein. or a reactive lymphoid proliferation to an unknown antigenic stimulation [2]. 7982, 2009. 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. His CT and MRI scans found only thickness of the oropharyngeal wall and epiglottal folds, and a superficial biopsy revealed only inflammation. CAS Two patients, including our patient, died during follow-up. b. H&E showed immunoblastic large cells with an obvious nucleolus (200 x). 88, no. External beam radiation has been successful in a single case [6]. https://doi.org/10.1016/j.leukres.2005.11.004. f. Tumour cells were negative for CD8 (200x). 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. Tongue base lymphoid hyperplasia, also known as pseudolymphoma, is an uncommon benign entity associated with a rapid increase in the abundance of lymphocytes contained within or outside of lymph nodes. When oral aggregates appear in clusters or have an unusual appearance or enlargement, clinicians may question whether abnormalities are present. Patients first experienced from varying degrees of throat discomfort and commit to the hospital with no B symptoms. 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. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Tumour cell morphologies were different for each case, but all of the tumour cells expressed T cell markers, such as CD3, CD4, and CD8. 2015;466:93100. https://www.linkedin.com/showcase/4000114/. Virchows Arch. 2002;15:4205. XS and QL did the HPV ISH. This is consistent with head and neck research findings [6, 26]. 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. This may be because the case occurred before drugs such as rituximab were widely available. Ren, X., Cheng, Y., Wu, S. et al. One case presented as multiple deep ulcers. As shown in Table1, all primary lesion locations were considered at the base of the tongue. 2014;118:33847. Ear Nose Throat J. Cases of PTCL and MCL are described in detail in the Results section. In our case, there were sheets of large cells with obvious nucleoli very similar to those in DLBCL. Like all lymphoid tissue in the body, oral lymphoid tissue is highly reactive and can enlarge from time to time as it reacts to foreign entities. M Gromet, M J Homer, B L Carter Published Online: Sep 1 1982 https://doi.org/10.1148/radiology.144.4.7111732 PDF Share Article History Published in print: 1982 Figures References Related Details Vol. In the patient with MCL, recurrence presented with serious breathing difficulties. 2, pp. Regezi JA, Sciubba JJ, Jordan RCK. 1998;112:9914. Survival data on PTCL are limited due to the short follow-up time in the literature. 2, pp. d. Tumour cells were positive for C-myc (200 x). https://doi.org/10.4149/BLL_2017_116. Clinicopathological information including age, gender, tumour location, histological subtype, grading, staging, survival, and response to treatment was acquired from the archives. Mamede RC, De Mello-Filho FV, Vigrio LC, Dantas RO. Aggregates of lymphoid tissue are all over the oral mucosa, but they are often prominent in the soft palate, uvula, and pharynx. Careers. Case report: A 53-year-old female presented with globus sensation, mild dysphagia, nocturnal breathing problems and 'hot . Radiol Clin North Am. 353358, 2001. The airway was subsequently secured, and the procedure was undertaken. https://doi.org/10.1007/s00428-014-1682-7. [2] Lymph node anatomy [ edit] Lewis JS Jr. Morphologic diversity in human papillomavirus-related oropharyngeal squamous cell carcinoma: catch me if you can! Briefly, the criteria and parameters for diagnosing and evaluating our cases were as follows: lymphoma classifications were based on the World Health Organization Classification of Tumors of Hematopoietic and Lymphoid Tissues (Revised Fourth Edition), and staging was based on the Ann Arbor Staging System. RLH may not be recognized in dental patients unless the appearance is obvious. Large B-cell lymphoma of the base of the tongue and oral cavity: a practical approach to identifying prognostically important subtypes. For DNA detection of high-riskin situ HPV infection, biotin-labelled HPV probe solutions (Leica, Newcastle, UK) were added to formalin-fixed, paraffin-embedded tissue sections. 4th ed. TIA, SOX10 was obtained from Beijing XiYaJinQiao Biological Technology Co. Ltd. China. Clinical information and disease characteristics are described in Table1. Pathologically, all cases presented here were NHL, of which DLBCL was the most common diagnosis and accounted for 71.4% of the patients. 1999;21:24754. CAS This is consistent with the findings from 17 DLBCL cases reported by Owosho AA et al. A lymphoid follicle under microscope is shown in Figure 2. FOIA Another reason might be HPV is not transcriptionally active in this patient; the virus integrated into the host DNA and remained inactive. Chi HS, Lee KW, Chiang FY, Tai CF, Wang LF, Yang SF, Lin SF, Kuo WR. 2009 Mar-Apr;75(2):195-9. doi: 10.1016/s1808-8694(15)30778-3. The cortex is also divided into outer cortex and inner cortex (also known as the paracortex). Mod Pathol. Oral and Maxillofacial Pathology. What does prominent lymphoid tissue at base of tongue on an MRI report mean. CAS https://doi.org/10.1309/YHFE-R65B-D3LK-3GGV. showed that 74% of DLBCL cases have P16 methylation and a relatively old age [32]. Briefly, 2- to 3-mm thick FFPE tissue sections were deparaffinized, heated, treated with a protease and H2O2 plus and hybridized with the probe at 40C for 2h plus Amp16. Kaohsiung J Med Sci. The https:// ensures that you are connecting to the St. Louis, MO: Elsevier; 2016. https://doi.org/10.1093/jnci/djn011. 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. The mean size is 2.5cm in the literature (range 15cm). https://doi.org/10.1080/02841860500531682. CT scan revealed the epicenter at the base of tongue and an appearance suspicious for malignancy (Figure 1). Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. AJR Am J Roentgenol. 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. 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]. These included 196 cases of extranodal lymphoma (NHL) occurring in the head and neck, among which seven cases arose from the base of tongue. DLBCL with high risk factors and MCL may have unfavourable outcomes. 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