Bilateral Tonsillar Enlargement as a First Manifestation of Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma with an Unusual Interfollicular Pattern of Infiltration

Duggal, Rajan; Rana, Abhyuday; Vaid, Ashok; Sood, Nitin; Handa, Kumud Kumar

doi:10.1007/s12288-015-0629-8

Cited by 6 publications

(5 citation statements)

References 13 publications

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“…Bilateral presentation is seen in 9-22 % of tonsil lymphoma, with a substantial risk in normalappearing asymmetric tonsils (13). Indolent lymphoma must be suspected in bilateral asymmetrical tonsillar enlargement with oropharyngeal symptoms refractory to medical management in the older age group (14). Two of the 13 patients in the present study manifested bilateral tonsillar enlargement.…”

Section: Discussionmentioning

confidence: 60%

Lymphomas of palatine tonsil in patients at a tertiary care centre in coastal India: A ten-year case analysis

Khadilkar¹,

Dosemane²,

Mithra³

et al. 2022

Biomedicine

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Introduction and Aim: Head and neck is affected in 11-33% of extra-nodal Non-Hodgkin Lymphomas with the Waldeyer’s ring comprising 50% and among which palatine tonsils are most commonly involved. Materials and Methods: A retrospective analysis was performed using medical case files to study the demographic and clinical details of 13 patients diagnosed with primary lymphoma of palatine tonsil between 2011 and 2020 at a tertiary care hospital in coastal India. Results: Mean age was 49.7 years with a male preponderance. The usual presentation was either as a unilateral palatine mass or neck swelling with dysphagia, odynophagia and otalgia. All patients had high-grade lymphoma, diffuse large B-cell lymphoma was the commonest type. B-symptoms were seen more often in B-cell lymphoma; stage I was the most frequent. Stage at diagnosis was statistically significant when compared with B-symptoms, bulky disease and International Prognostic Index (IPI) (p-values of 0.02, 0.02 and 0.035 respectively). Overall survival (OS) rate was 44.44%, being higher in females than in males. Higher OS rate was noted for IPI of 1 & 2, and early stage lymphoma, unilateral tonsillar enlargement, normal lactate dehydrogenase, and European Cooperative Oncology Group score of 0. Combined chemoradiation proved to be better (50% OS) than chemotherapy (33.33% OS) alone. Conclusion: Lymphoma must be suspected in unilateral or bilateral asymmetrical tonsillar enlargement, especially in the older age group. Histopathology with immunohistochemistry plays a crucial role in diagnosis and typing of lymphoma, for proper and early institution of treatment with chemoradiation.

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Section: Discussionmentioning

confidence: 60%

Lymphomas of palatine tonsil in patients at a tertiary care centre in coastal India: A ten-year case analysis

Khadilkar¹,

Dosemane²,

Mithra³

et al. 2022

Biomedicine

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“…17 Chronic lymphocytic leukaemia/small lymphocytic lymphoma is a rarer histopathological diagnosis following histology tonsillectomy. To our knowledge, there are no previously published reports of chronic lymphocytic leukaemia/small lymphocytic lymphoma presenting as unilateral tonsil enlargement, but reports have been published of chronic lymphocytic leukaemia/small lymphocytic lymphoma presenting with bilateral tonsil enlargement, 18 and indeed chronic lymphocytic leukaemia infiltrating Waldeyer's ring and causing upper airway obstruction. 19 We were able to quantitatively calculate estimated tonsil volume for excised tonsils and compare this with documented pre-operative examination findings.…”

Section: Discussionmentioning

confidence: 98%

Unilateral tonsil enlargement in children and adults: is routine histology tonsillectomy warranted? A multi-centre series of 323 patients

2022

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Background. This study aimed to establish whether histology tonsillectomy is justified for unilateral tonsil enlargement. Methods. A retrospective review was conducted of histology tonsillectomies in three health organisations over five years, with strict exclusion criteria, focusing on benign-appearing unilateral tonsil enlargement. Results. Ninety paediatric and 233 adult cases were included. No paediatric cases and five adult cases of malignancy were detected. All malignant cases presented with other symptoms. Using binary logistic regression, a history of rapid unilateral tonsil enlargement was the only factor found to be significantly associated with malignant outcome. Thirty-three per cent of subjectively larger tonsils were smaller on post-operative histological measurement. Of the cases, 12.1 per cent re-presented with post-tonsillectomy bleeding. Conclusion. The authors recommend avoiding histology tonsillectomy for unilateral tonsil enlargement unless 'red flag' signs of malignancy are present, with particular attention to rapid unilateral tonsil enlargement. This study demonstrated discrepancy between clinical examination findings and true tonsil asymmetry; there may be a role for cross-sectional imaging prior to histology tonsillectomy in high-risk patients.

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“…Occasionally, these examinations may reveal some underlying pathological findings that have been masked as OSA. There have been reported cases of OSA as the first manifestation of chronic lymphocytic leukaemia (1).…”

Section: Discussionmentioning

confidence: 99%

Mantle Cell Lymphona Masquerading as Obstructive Sleep Apnoea

Ishak¹,

Mahat²

2023

MJMHS

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Tonsillar malignancy typically presents with asymmetrical tonsillar enlargement, lesion on the tonsils, sore throat or a neck mass. We report a case of unsuspected tonsillar malignancy in a 56-year-old gentleman who presented with symptoms of obstructive sleep apnoea. His tonsils were grade III bilaterally with normal mucosa. Tonsillectomy was performed to improve patient’s compliance with Continuous Positive Airway Pressure (CPAP) therapy. These tonsillar specimens were reported to be Mantle Cell Lymphoma (MCL) based on the histology and ancillary studies. This case highlights that benign-looking symmetrical tonsillar enlargement can harbour occult malignancy. It is important to note that OSA symptoms may be the presentation for haematological malignancies. Tonsillar specimens should be sent for histopathological examination regardless of the indication to avoid misdiagnosis and delay in treatment.

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Bilateral Tonsillar Enlargement as a First Manifestation of Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma with an Unusual Interfollicular Pattern of Infiltration

Cited by 6 publications

References 13 publications

Lymphomas of palatine tonsil in patients at a tertiary care centre in coastal India: A ten-year case analysis

Lymphomas of palatine tonsil in patients at a tertiary care centre in coastal India: A ten-year case analysis

Unilateral tonsil enlargement in children and adults: is routine histology tonsillectomy warranted? A multi-centre series of 323 patients

Mantle Cell Lymphona Masquerading as Obstructive Sleep Apnoea

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