MALT LYMPHOMA OF PALATE AND ORBIT
Abstract TITLE: Malt palate and orbit lymphoma Authors: CIFUENTES NAVAS-Viviana Andrea; MARTÍN PASCUAL- María Consolación; FERNÁNDEZ RODRÍGUEZ- Ana; ALONSO MESONERO- Marta; CHAVIANO GRAHJERA-Juan; MORAIS PÉREZ-Darío. INTRODUCTIONMALT-type lymphomas are lymphoid proliferations originated in the glandular epithelium of organs like the stomach, the salivary and lacrimal glands, and even, we can find lymphoid neoformations of non-epithelial localization, like in the orbital soft tissue. The lymphomas of the mucosal-associated lymphatic tissue (MALT) represent only 0.2-0.3% and constitute a well-defined group of non-Hodgkin lymphomas of B origin. In the field of oral pathology, the salivary glands, tonsils and palate are mainly affected, it is more rare to find it in jugal mucosa.We present a rare case of MALT lymphoma with involvement of the palate and orbit. MATERIAL AND METHODS84-year-old patient with multiple pathologies. Derived from his primary care physician due to pharyngeal complaints of 4 to 5 days of evolution, associated with a painful palate lesion.He presented in right hemipaladar a tumoration of elastic consistency in submucosa, ulcerated in the center, with normal neck. Also left orbital tumor that limits the visual field. RESULTSCT and MRI of the neck report mass of 4x4 x2.5 cm in right hemipaladar, noninfiltrating concordant with possible lymphoma. The orbital MRI describes an intra and extra nasal left nasal lesion of 2.3x1.2x2 cm with characteristics consistent with lymphoma. CT of the neck: It demostrates a great mass of right hemipaladar, with lobulated contours and homogeneous enhancement of 40x32x25 mm, in intimate contact with medial pterygoid muscle, although there were no signs of infiltration, the rest of the edges being well delimited. Images characteristics look like a lymphoma, without being able to rule out other etiologies. MRI of the neck: It demostrates a diffuse thickening of right side of the soft palate that acquires a tumour morphology of 4x4x2.2 cm, well defined that does not infiltrate adjacent tissues. It enhances intensely and homogeneously with contrast. There are bilateral laterocervical ganglionic images ,with predominance in right side, nonspecific.Orbit MRI: It demostrates mixed orbital mass intra and extraconal on the left side, oval morfology, Its limits are partially well-defined, with transverse diameters 2.3x1.1 cm and craniocaudal 2cm approximately, it show a moderate and diffuse enhance after endovenous contrast. The result of the biopsy of both lesions indicated infiltration of "B" lymphoma type MALT lymphoma. The patient was referred to the service of hematology, found no adenopathies or visceromegalies. It was cataloged like a lymphoma NO HODGKIN B malt type STAGE IV-A (two extranodal sites, orbit and palate), He is currently with chemotherapy treatment, and he is followed up by this department. CONCLUSIONS MALT lymphoma affects adults older than 60 years mainly, showing a slight female predominance, and more probably for gastric locations. The clinical characteristics and the presentation of the symptoms are mainly related to the primary location of the tomour. Approximately 6% of the non-hodgkin lymphomas that affect Waldeyer's ring are MALT lymphomas, affecting most of them to the palatine amygdala. However, according to the reviewed bibliography, the affectation of the palate is rare, being more frequent the orbital location MALT lymphomas follow a relatively indolent clinical course and generally remain localized in their primary extranodal site. Tumors are sensitive to radiation therapy and local treatment. However, dissemination at multiple sites is not infrequent, it may involve extra-ganglionic sites, such as bone marrow, spleen and liver. Early diagnosis is the basis of a better prognosis, this allows a more adequate treatment. The role of the in-depth clinical study is emphasized and confirmed by a biopsy. It is important the multidisciplinary treatment of the patient from the departments of oncology, hematology with radio and chemotherapy, etc. The follow-up of the patient has to be long.We have reviewed the literature,and we found that MALT lymphomas with palate involvement in association with the orbit are extremely rare; It is because we think is important to publish this case.
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1.Dr. Luciano Mendonça1 ; Dr. Leopoldo Cordero2; Dr. Alvaro Páez3; Dr. Santiago Risso3; Dr. Enrique Zamar3.Tumores malignos de amígdala palatina Malignant tumors of palatine tonsil.
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6. Román Carlos Bregni, DDS,a Michel Nuyens, MD,a José Vassallo, MD, PhD,b Fernando Augusto Soares, MD, PhD,c Mário José Romañach. Marginal zone lymphoma of mucosa-associated lymphoid tissue with prominent plasma cell differentiation affecting the palatine tonsil: histopathological and immunohistochemical analysis. Vol. 113 No. 4 April 2012.
7.Carlos Bregni R1, Nuyens M, Vassallo J, Soares FA, Romañach MJ, León JE, Almeida OP. Marginal zone lymphoma of mucosa-associated lymphoid tissue with prominent plasma cell differentiation affecting the palatine tonsil: histopathological and immunohistochemical analysis. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012 Apr;113(4):526-32. doi: 10.1016/j.oooo.2011.11.002.
2.Dr. Fernando Martín Linfoma en Otorrinolaringología De los Servicios de Radiología del Hospital Conde de Valenciana y de la Unidad de Radiodiagnóstico, S.A. de C.V. 2 Hospital General de México y Servicio de Radiología del Hospital Conde de Valenciana. Chimalpopoca 14, Col. Obrera, C.P. 06800, México, D.F.
3.CARTAS AL DIRECTOR Linfoma MALT de localización oral versión impresa ISSN 1131-5768 Medifam vol.11 no.9 oct./nov. 2001.
4. MsC. Ana Dolores Izquierdo Calzado, MsC. Juan Carlos Espinosa Expósito, Dr. José Jardón Caballero, Dr. Jesús Díaz Fondén, Dra. Frida Yarina González NúñezLinfoma MALT en diferentes localizaciones MALT lymphoma in different locations Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres", Santiago de Cuba, Cuba.
5. Ana Quintana Sanjúas. Olalla Castro Macía. Miriam Hamdan Zavarce. Adela Perez Carrp-Rios. Isabel González Guijarro. Estrella Pallas Pallas. Manuela Fontanillo Fontanillo.Manifestaciones de los linfomas en el área ORL.
6. Román Carlos Bregni, DDS,a Michel Nuyens, MD,a José Vassallo, MD, PhD,b Fernando Augusto Soares, MD, PhD,c Mário José Romañach. Marginal zone lymphoma of mucosa-associated lymphoid tissue with prominent plasma cell differentiation affecting the palatine tonsil: histopathological and immunohistochemical analysis. Vol. 113 No. 4 April 2012.
7.Carlos Bregni R1, Nuyens M, Vassallo J, Soares FA, Romañach MJ, León JE, Almeida OP. Marginal zone lymphoma of mucosa-associated lymphoid tissue with prominent plasma cell differentiation affecting the palatine tonsil: histopathological and immunohistochemical analysis. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012 Apr;113(4):526-32. doi: 10.1016/j.oooo.2011.11.002.
Cifuentes Navas, V. A., Martín Pascual, M. C., Fernández Rodríguez, A., Alonso Mesonero, M., Chaviano Grajera, J., & Morais Pérez, D. (2018). MALT LYMPHOMA OF PALATE AND ORBIT. Revista ORL, 9(6), 3.30. https://doi.org/10.14201/orl.18268
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