Department of Pathology, Tzaneion General Hospital, Piraeus, Greece
*Corresponding author Email: email@example.com
Non-Hodgkin's lymphoma of the Waldeyer's ring is a relatively rare entity and the palatine tonsil is the most frequently involved site. Although, the exact aetiology remains unclear, a number of predisposing factors have been identified, including human immunodeficiency virus and Epstein-Barr infection. We report a case of localised extranodal non-Hodgkin's lymphoma of the tonsil.
A 64-year-old woman presented with a sore throat. On physical examination, an approximately 2 × 1 cm smooth non-tender mass was observed in the left palatine tonsil. Serology was negative for human immunodeficiency virus and Epstein-Barr virus. Computer tomography scan revealed a non-enhancing left tonsillar mass but no signs of neck lymphadenopathy. The patient underwent bilateral tonsillectomy. Histological examination confirmed a diagnosis of non-Hodgkin's lymphoma diffuse large cell type of B phenotype. Immunohistochemically, the neoplastic cells were positive for CD19, CD20, CD10, CD79a, CD22, Bcl-2, Bcl-6 and negative for CD57, CD56, CD2, EBV, CD4, CD5, CD7, CD8, S-100p, CD3, Cyclin D1, CD1a, HMB45, CKAE1 and CKAE3. Bone marrow biopsy did not reveal lymphomatous involvement (stage I according to tumour, node, metastasis classification). The patient received chemotherapy based on CHOP (cyclophosphamide, doxorubicin, vincristine and prednisolone) protocol combined to Rituximab. During follow-up, she remains disease-free 30 months after diagnosis.
Non-Hodgkin's lymphoma rarely involves tonsils with the diffuse large B-cell type being common at this location. A combined treatment consisting of chemotherapy and radiotherapy leads to a satisfactory outcome in patients with this uncommon neoplasm, which tends to present at an early stage and to have a favourable prognosis.