LINFOMA EXTRAGANGLIONAR EN RINOFARINGE: A PROPÓSITO DE UN CASO

Abstract

Introduction: Non-Hodgkin lymphoma (NHL) can develop in extranodal areas more frequently than Hodgkin lymphoma, 60% of cases versus 2% in LH. 60% of the extranodal regions are limited to head and neck.Extranodal lymphoma originates in different organs than lymph node. Areas rich in lymphoid tissue, such as Waldeyer's ring, represent more than half of the cases; Other locations of greater to lower frequency may be the orbits, salivary glands, thyroid, nasal and paranasal pits and larynx.Case report: A 82-year-old woman was followed up by Hematology for 5 years for Chronic Lymphatic Leukemia. During Dacryocystorhinostomy a lesión on the roof of the left nasal pit was found, which was biopsied, resulting an infiltration by lymphocytes suggestive of lymphoproliferative process. Six months later she came for sudden bilateral loss of hearing. During the examination, a large cavum mass was evidenced, confirmed by a cervico-facial CT, which reflects an asymmetry with slight diffuse thickening of the nasopharynx, mainly on the left side, poorly delimited, without bone destruction of the base of the skull. It also presents submandibular and laterocervical adenopathies of up to 1.1 cm, larger in levels IA and IIB. A biopsy is taken.Results: The anatomopathological report of the sample suggests the presence of a lymphoproliferative process with lymphocytes of small to medium size, with anisocytosis and slightly irregular nuclei, some of them with cleft. They express CD5 and CD20, and are negative for CD10, Cyclin D1 and SOX-11. MALT-1 is negative. Ki-67 is positive in 25% of the cells. It can not be completely ruled out that it is a MALT lymphoma with CD5 expression (uncommon or exceptional in lymphomas of mucosal-associated lymphoid tissue). However, the morphology of the lesion and the clinical history of the patient are more typical of a Mantle Cell lymphoma (CD5 positive), although Cyclin-D1 and SOx-11 have been negative, which is also possible but not frequent in this type of lymphomas. Given the discrepancy in the diagnosis, HISS t (4:14) of mantle lymphoma and chemotherapy with R-Bendamustine was started.Conclusions: Extranodal lymphomas in the head and neck are mainly non-Hodgkin lymphomas. The Waldeyer's Ring is the most frequent location in the head and neck area, representing more than half of the extra-ganglionic lymphomas in this area, which according to some authors reaches 10% of all lymphomas. Imaging tests are a great help for diagnosis and staging. In the presence of homogeneous lymph nodes with lesions in Waldeyer's ring, suspect lymphoma. The use of special techniques of immunohistochemistry and electron microscopy is essential for its differential diagnosis. In most cases, a systemic treatment with chemotherapy will be chosen.