Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2020, Vol. 34 ›› Issue (1): 115-120.doi: 10.6040/j.issn.1673-3770.0.2019.490

Previous Articles    

Mantle cell lymphoma involving the Waldeyer's ring: a case series and literature review

WEN Feng1, WANG Bingjie2, HU Xihao1, ZHAO Enmin1   

  1. 1. Department of Otorhinolaryngology Head and Neck Surgery, Peking University first Hospital, Beijing 100034, China;
    2. Department of Hematology, Peking University first Hospital, Beijing 100034, China
  • Published:2020-03-06

Abstract: Objective To analyze the clinical characteristics of mantle cell lymphoma(MCL)of the Waldeyer's ring. Methods A retrospective study of 4 patients with MCL in the Waldeyer's ring, treated in the department of otolaryngology, head and neck surgery of Peking University First Hospital between 2016 and 2019 were used in this review. Their clinical manifestations, histopathology, immunohistochemistry, cytogenetics, the treatment used, and prognosis were summarized and analyzed in combination with a literature review. Results MCL involving the Waldeyer's ring is extremely rare. The palatine tonsil is the most frequently involved site, followed by the nasopharynx and tongue base. They generally present with asymptomatic soft tissue swelling and typically lack the systemic B symptoms. When the tumor is large, there are corresponding obstruction symptoms. For MCL in the nasopharynx, the symptoms are a unilateral or bilateral nasal obstruction with or without ear fullness. For MCL in the palatine tonsil or tongue base, the most common symptoms were a sensation of fullness of the throat, difficulty swallowing, and not having clear speech because of the tumor in the oral cavity. Examination revealed soft tissue swelling of the nasopharynx, palatine tonsil or tongue base. MCL was diagnosed by examining the affected tissue obtained from a biopsy of the lymph node, tissue, bone marrow, or blood phenotype. MCLs have distinct immunophenotype expressing pan B-cell markers(CD 19, 20, and 22). Generally, the T-cell marker CD5 is also expressed, giving this tumor a characteristic profile. The most sensitive and specific marker for MCL is CyclinD1, of which almost all cases are moderately to strongly positive. MCL is characterized by a genetic profile of t(11;14)(q13;q32)in nearly all cases that can be evaluated by conventional cytogenetics and fluorescencein situ hybridization. MCL patients frequently present at an advanced disease stage with extranodal involvement, resulting in poor clinical outcomes due to frequent relapse and the aggressive course. Treatment options for MCL vary widely, with poor prognosis. Conclusions MCL may rarely occur in the Waldeyer's ring. It may be diagnostically challenging to differentiate from other lymphomas that may occur in this area. However, it exhibits some distinctive histological and immunohistochemistry traits which can help distinguish it. Due to the poor overall prognosis, early identification would be important in providing individualized treatment. Rituximab combined with chemotherapy and the use of new drugs such as ibrutinib can improve the prognosis of patients.

Key words: Waldeyer's ring, Mantle cell lymphoma, Non-Hodgkin's lymphoma

CLC Number: 

  • R766
[1] Ezzat AA, Ibrahim EM, El Weshi AN, et al. Localized non-Hodgkin's lymphoma of Waldeyer's ring: clinical features, management, and prognosis of 130 adult patients[J]. Head Neck, 2001, 23(7): 547-558. doi:10.1002/hed. 1077.
[2] Vose JM. Mantle cell lymphoma: 2015 update on diagnosis, risk-stratification, and clinical management[J]. Am J Hematol, 2015, 90(8): 739-745. doi:10.1002/ajh. 24094.
[3] 高大林, 付骞千, 张甜甜, 等. 112例原发性韦氏环淋巴瘤的临床病理特征及预后分析[J]. 中国实验血液学杂志, 2015, 23(5): 1301-1308. doi:10.7534/j.issn.1009-2137. 2015.05.015. GAO Dalin, FU Qianqian, ZHANG Tiantian, et al. Analysis of clinicopathological characteristics and prognosis of 112 patients with primary waldeyer's ring lymphoma[J]. J Exp Hematol, 2015, 23(5): 1301-1308. doi:10.7534/j.issn.1009-2137. 2015.05.015.
[4] 李超, 安云芳, 辛凤, 等. 首诊于耳鼻咽喉科的套细胞淋巴瘤一例[J]. 中华耳鼻咽喉头颈外科杂志, 2016, 5l(3): 218-220. doi: 10.3760/cma.j.issn.1673-0860. 2016.03.013. LI Chao, AN Yunfang, XIN Feng, et al. A case of mental cell lymphoma first diagnosed at otorhinolaryngology[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2016, 5l(3): 218-220. doi: 10.3760/cma.j.issn.1673-0860. 2016.03.013.
[5] 祁雪萍, 冀永进, 赵长青, 等. 复发性腭扁桃体套细胞淋巴瘤一例[J]. 中华耳鼻咽喉头颈外科杂志, 2017,52(7): 544-546. doi: 10.3760/cma.j.issn.1673-0860. 2017.07.015. QI Xueping, JI Yongjin, ZHAO Changqing, etal. A case report of recurrent mental cell lymphoma involving tonsils[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2017,52(7): 544-546. doi: 10.3760/cma.j.issn.1673-0860. 2017.07.015.
[6] 陈钢, 刘敏, 艾建伟, 等. 首发于咽淋巴环的套细胞淋巴瘤1例[J]. 中国耳鼻咽喉头颈外科, 2017, 24(12): 661-662. doi:10.16066/j.1672-7002. 2017.12.018
[7] 侯卫华, 韦萍, 谢建兰, 等. 扁桃体套细胞淋巴瘤临床病理学特点及预后[J]. 中华病理学杂志, 2018, 47(3): 158-162. doi: 10.3760/cma.j.issn.0529-5807. 2018.03.002. HOU Weihua, WE Ping, XIE Jianlan, et al. Clinicopathologic characteristics and prognositic indicators of tonsillar mantle cell lymphoma[J]. Chinese Journal of Pathology, 2018, 47(3): 158-162. doi: 10.3760/cma.j.issn.0529-5807. 2018.03.002.
[8] 胡美薇, 娄引军, 杨敏, 等. 140例套细胞淋巴瘤临床分析[J]. 中华肿瘤杂志 2018, 40(5): 390-395. doi: 10.3760/cma.j.issn.0253-3766. 2018.05.013. HU Meiwei, LOU Yinjun, YANG Min, etal. Clinical analysis of 140 cases of mantle cell lymphoma[J]. Chinese Journal of Oncology, 2018,40(5): 390-395. doi:10.3760/cma.j.issn. 0253-3766. 2018.05.013.
[9] Kang JH, Park YD, Lee CH, et al. Primary mantle cell lymphoma of the nasopharynx: a rare clinical entity[J]. Braz J Otorhinolaryngol, 2015, 81(4): 447-450. doi:10.1016/j.bjorl. 2015.02.002.
[10] Paul M, Asmi NH, Omar EK, et al. Nasopharyngeal mantle cell lymphoma: an extremely rare entity[J]. Oman Med J, 2019, 34(1): 74-77. doi:10.5001/omj. 2019.13.
[11] Rao R, Dosemane D, Jaipuria B, et al. Mantle cell lymphoma of the palatine tonsil: A rare case report[J]. Iran J Otorhinolaryngol, 2018, 30(100): 297-300.
[12] Rosenwald A, Wright G, Wiestner A, et al. The proliferation gene expression signature is a quantitative integrator of oncogenic events that predicts survival in mantle cell lymphoma[J]. Cancer Cell, 2003, 3(2): 185-197. doi:10.1016/s1535-6108(03)00028-x.
[13] Geisler CH, Kolstad A, Laurell A, et al. The mantle cell lymphoma international prognostic index(MIPI)is superior to the international prognostic index(IPI)in predicting survival following intensive first-line immunochemotherapy and autologous stem cell transplantation(ASCT)[J]. Blood, 2010, 115(8): 1530-1533. doi:10.1182/blood-2009-08-236570.
[14] National Comprehensive Cancer Network. Clinical practice guidelines in oncology[M]. Mantle cell lymphoma, Version 2019.
[15] Diamond B, Kumar A. Mantle cell lymphoma: current and emerging treatment strategies and unanswered questions[J]. Hematol Oncol Clin North Am, 2019, 33(4): 613-626. doi:10.1016/j.hoc. 2019.03.002.
[16] Wang ML, Rule S, Martin P, et al. Targeting BTK with ibrutinib in relapsed or refractory mantle-cell lymphoma[J]. N Engl J Med, 2013, 369(6): 507-516. doi:10.1056/NEJMoa1306220.
[1] Zhaokun WU,Xinhua ZHU. Can adenotonsillectomy adequately cure children with obstructive sleep apnea syndrome [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(5): 148-152.
[2] Lei WANG,Gang WANG,Wei WU,Hongdan LIU,Bingxin XU,Xin LI,Haolun HAN,Baowei LI,Ruiying DING,Lianyong LI. Simultaneous Dx-pH monitoring of the oropharynx and esophagus for laryngopharyngeal reflux disease research [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(5): 101-106.
[3] JI Di, CHEN Xiang, YU Lin. Soft palate surgeries with hyoid bone suspension for obstructive sleep apnea hypopnea syndrome with glossoptosis: a meta-analysis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(4): 124-130.
[4] HUANG Jiyi, LI Baizi, WU Shunong, LÜ Zhenghua. Clinical efficacy of the pharyngopalatine arch muscle mucosal flap for tonsillectomy wound closure after plasma surgery [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(4): 92-95.
[5] SONG Fan, HUANG Weijun, XU Huajun, GUAN Jian, YI Hongliang. Relationship between carotid elasticity and oxidative stress in patients with obstructive sleep apnea syndrome [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(4): 99-104.
[6] CHEN Chun, DING Jian, XIE Jin. Effects of continuous positive airway pressure therapy on inflammatory markers in obstructive sleep apnea syndrome: a meta-analysis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(4): 131-137.
[7] Min YIN,Lei CHENG. Comments and opinions on the nomenclature of snoring disease [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(3): 19-22.
[8] LI Shaonan, YU Dan, WEN Lianji. Research progress on the relationship between obstructive sleep apnea syndrome and diseases of the respiratory and circulatory systems [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(1): 140-144.
[9] ZHOU Dingkun, CAI Yu,TIAN Yanhua, TENG Bo, FENG Qingjie. A case report of Grisel syndrome following adenoidectomy in Crouzon children [J]. J Otolaryngol Ophthalmol Shandong Univ, 2018, 32(5): 119-120.
[10] LÜ Xuqin, WAN Wenjin. Perioperative blood glucose management in patients with obstructive sleep apnea hypopnea syndrome and hyperglycemia [J]. J Otolaryngol Ophthalmol Shandong Univ, 2018, 32(4): 100-104.
[11] DAI Yacuo, LI Jing, WAN Baoluo, ZANG Yanzi, HUANG Yingming. Individualized treatment of pharyngeal and laryngeal cavernous hemangioma:a report of two cases. [J]. J Otolaryngol Ophthalmol Shandong Univ, 2018, 32(4): 110-112.
[12] WANG Gang, WU Wei, WANG Lei, LIU Hongdan, XU Xiaohang, XU Bingxin, DING Ruiying, ZHOU Ying, HAN Haolun, GONG Jing,LI Baowei, SUN Zhezhe. Correlation analysis between Ryan index and reflux symptom index and reflux finding score, in the diagnosis of [J]. J Otolaryngol Ophthalmol Shandong Univ, 2018, 32(4): 48-52.
[13] XU Wen, TANG Wei, YU Shaoqing, LI Shaohui, GE Rongming. Treatment of pharyngeal and laryngeal hemangiomas with pingyangmycin [J]. J Otolaryngol Ophthalmol Shandong Univ, 2018, 32(4): 62-64.
[14] LIU Dabo. Evaluation of sleep structure disorder in children with obstructive sleep apnea hypopnea syndrome [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2018, 32(2): 6-8.
[15] LI Yanzhong, ZHANG Tai. Problems we face in children with obstructive sleep apnea hypopnea syndrome [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2018, 32(2): 1-5.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!