Primary mantle cell lymphoma of the tonsil: An uncommon case

Abstract

Non-Hodgkin 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. An 82-year-old male patient presented with a sensation of fullness of the throat. Physical examination revealed a smooth non-tender mass in the right palatine tonsil measuring approximately 3.5 x 3cm. Serology was negative for human immunodeficiency virus and Epstein- Barr virus. Computer tomography revealed a non-enhancing right tonsillar mass but without any signs of neck lymphadenopathy. The patient underwent bilateral tonsillectomy. Histological examination confirmed a diagnosis of mantle cell lymphoma of B phenotype. Immunohistochemically, the neoplastic cells were positive for CD19, CD20, CD79a, CD22, Bcl 2, CD5, Cyclin D₁ and negative for CD10, CD57, EBV, CD3, CKAE1, CKAE3. Bone marrow biopsy did not reveal lymphomatous involvement. The patient received chemotherapy based on CHOP protocol combined with Rituximab. At 18-month follow-up after diagnosis, he remains disease-free. Non-Hodgkin lymphomas rarely involve the tonsils and the vast majority of them are of B-cell origin. A combined treatment consisting of chemotherapy and radiotherapy leads to a satisfactory outcome in patients with this uncommon neoplasm. The current results supported its good prognosis at early stage.