Tonsil lymphoma presenting as tonsillitis after bone marrow transplantation

Abstract

Bone marrow transplantation for the treatment of leukemia is increasingly successful in rendering patients disease free. However, it has become evident that the associated severe immunosuppression predisposes this population to an increased risk for other neoplastic disorders. We report on six patients in whom non-Hodgkin's lymphoma of the tonsillar region developed within 5 months after T-cell-depleted bone marrow transplantation for the treatment of leukemia at Memorial Sloan-Kettering Cancer Center from October 1990 to October 1992. These patients initially had what appeared to be infectious exudative pharyngitis/tonsillitis; however, they did not improve with medical therapy. Because of the persistence of pharyngitis/tonsillitis in association with cervical lymphadenopathy and odynophagia, the patients underwent definitive biopsy in the form of tonsillectomy, cervical lymph node biopsy, or both. Histopathologic review revealed non-Hodgkin's lymphoma. An association with Epstein-Barr virus has been noted in five of these patients. This article is aimed at alerting the clinician to consider the diagnosis of lymphoma in a patient with persistent pharyngitis/tonsillitis despite adequate medical therapy after bone marrow transplantation.

Adenotonsillar Enlargement in Pediatric Organ Transplant Recipients: A Cross‐Sectional Analysis

“…PTLD often presents in the region of Waldeyer's ring as ATH. [4][5][6][7]12 In a recent retrospective study of children having undergone liver transplantation over a 14-year period (1984 to 1998), 39% of those who underwent adenotonsillectomy for airway obstruction or asymptomatic tonsillar enlargement were noted to have EBV-related hyperplasia in the adenotonsillar tissue. 13 Given the high incidence of EBV-related hyperplasia, we feel strongly that even asymptomatic ATH should be surgically addressed in this population.…”

“…Furthermore, the clinical significance of such hypertrophy in the immuno‐suppressed patient is not entirely clear. However, previous studies have demonstrated that ATH in the pediatric posttransplant population can represent PTLD 3–7 . Therefore, we sought to evaluate a large population of pediatric transplant recipients, focusing on signs and symptoms of ATH.…”

“…PTLD has been noted to present with adenotonsillar hypertrophy (ATH) in several recent reports 4–7 . Lones et al 5 reported 3 cases of PTLD in which adenotonsillar biopsy enabled early diagnosis and treatment, resulting in improved patient outcomes 5 .…”

Unilateral Tonsillar Enlargement and Tonsillar Lymphoma in Children

“…In our series, TL developed in previously healthy children. It has been reported to occur as a second malignancy, 12 and in association with immunosuppression following bone marrow 13 and heart transplantation. 14 Abnormalities of the tonsils should clearly be regarded with great suspicion in the transplant population.…”

Processing of Adenoid and Tonsil Specimens in Children: A National Survey of Standard Practices and a Five‐Year Review of the Experience at the Children's Hospital of Pittsburgh

“…On review of the literature, we found several isolated anecdotal case reports of unsuspected diagnoses in routine T%A specimens. As one might expect, the most common diagnosis was lymphoma, 4–8 but other diagnoses included but were not limited to Epstein‐Barr virus lymphoproliferative disorder, 9 Langerhans' cell histiocytosis, 10 pemphigus vulgaris, 11 teratoma, 12 rhabdomyosarcoma, 13 and sarcoidosis 14…”