Primary non-Hodgkin lymphoma of the tongue base: the clinicopathology of seven cases and evaluation of HPV and EBV status

Abstract

Objectives: Non-Hodgkin's lymphoma (NHL) primarily derived from the base of the tongue, is rare. Human papillomavirus (HPV) and Epstein-Barr virus (EBV) are important aetiological risk factors for tumours of the head and neck. This study describes the clinicopathological features of NHL in the tongue base and the status of HPV and EBV in these cases. Methods: Seven cases were identified from the Pathological Registry Database at Peking Union Medical College Hospital (PUMCH). The study utilized immunochemistry, in situ hybridization (ISH), and gene rearrangement to confirm the disease and and performed a clinical follow up for each case. Results: All 7 lymphomas were localized at the base of the tongue. Six of the cases exhibited tongue base masses with smooth surface membranes. One case presented as multiple deep ulcers. The most common histologic subtype was diffuse large B-cell lymphoma (DLBCL), which occurred in five cases. The other two cases were mantle cell lymphoma (MCL) and peripheral T cell lymphoma, not otherwise specified (PTCL, NOS). One of the DLBCL cases was positive for HPV DNA and diffusely expressed P16 protein. During the follow up period, the MCL patient and an elderly DLBCL patient died. The remaining five patients were alive through the end of follow up. Conclusions: Most lymphomas of the tongue base manifest as an endogenous mass without membranous change. The most common subtype of NHLs of the tongue base is DLBCL, and the occurrence at this site may have a good prognosis. With proper therapy, even late stage tongue base lymphomas can be suppressed and remain in remission.

A Rare Presentation of Acute Respiratory Distress Due to Diffuse Large B-Cell Lymphoma of the Tongue Base

“…Primary DLBCL of the tongue base is a rare entity with only 14 cases described in the English literature to date. The incidence of BOT NHLs increases with age, most commonly after the sixth decade of life with no observed gender differences [ 4 ]. The most common head and neck site for extranodal malignant lymphomas involves Waldeyer’s ring, an annular area of lymphoid tissue from the nasopharynx down each lateral pharyngeal wall to the palatine tonsils before meeting again at the base of the tongue.…”

“…NHLs occur more commonly in patients with a prior history of congenital immunodeficiency and celiac disease, exposure to radiation, acquired immune deficiency syndrome, rheumatoid arthritis, or Sjögren’s syndrome [ 5 ]. Most reported cases of NHLs of the tongue base may cause dysphagia, pharyngeal foreign body sensation, or progressive dyspnea [ 4 , 6 , 7 ]. The patient presented with a six-month history of right neck swelling, one-month history of dysphagia, change in voice, and acute airway distress, which led to a tracheostomy.…”

“…SCC was felt to be the most likely initial diagnosis for our patient despite the lack of tobacco/nicotine and alcohol use history because of the overall increasing oropharyngeal cancer incidence attributed to increased human papillomavirus infection exposure [ 9 ]. Imaging such as CT or magnetic resonance imaging can help delineate NHL disease extent, but the diagnosis can only be confirmed by biopsy and immunohistochemical analysis [ 4 ]. Lingual thyroids are an uncommon congenital diagnosis, with papillary thyroid cancer arising in this site rarer still [ 10 ].…”

Base of Tongue Non-Hodgkin’s Lymphoma: Difficult Intubation

“…The mean survival was two years [10]. Even late-stage NHL involving the base of the tongue with R-CHOP treatment can be suppressed and remain in remission, and the occurrence at this site may have a good prognosis [11].…”

Symptomatic Thyroglossal Duct Cyst Presenting With Synchronous and Localized Tongue Base Extranodal Mantle Cell Lymphoma. A Unique Case Report Demonstrating Lymphoma Colonization of Cyst Wall, Potentially Relating to a Persistent Embryological Foramen Cecum Remnant

“…This case is unique, given the lack of evidence of disseminated MCL involvement, heightening the likelihood of local progressive disease as the cause of the symptomatic TGDC. 11-15 MCL possesses a histologically distinct phenotype with diffuse, monotonous and/or nodular proliferation of small-medium sized cells characterized by cyclin-D1 overexpression, triggering the hyperphosphorylation of the retinoblastoma tumor suppressor, and the subsequent erosion of the G1-S cell-cycle check point. 11 Thus, MCL can be distinguished from other morphologically types of NHL by diffuse overexpression of cyclin-D1 as well as other surface markers including CD20 and aberrant expression of CD5.…”