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|Year : 1986 | Volume
| Issue : 2 | Page : 103-4
Primary non-Hodgkin's lymphoma of larynx (a case report).
Ghosh KC, Chatterjee DN, Mukherjee DD, Mondal AA, Mukherjee AL
|How to cite this article:|
Ghosh K C, Chatterjee D N, Mukherjee D D, Mondal A A, Mukherjee A L. Primary non-Hodgkin's lymphoma of larynx (a case report). J Postgrad Med 1986;32:103
|How to cite this URL:|
Ghosh K C, Chatterjee D N, Mukherjee D D, Mondal A A, Mukherjee A L. Primary non-Hodgkin's lymphoma of larynx (a case report). J Postgrad Med [serial online] 1986 [cited 2020 Apr 4];32:103. Available from: http://www.jpgmonline.com/text.asp?1986/32/2/103/5359
The incidence of non-Hodgkin's lymphoma originating in extranodal sites ranges from 10-35%. Any histological type may present in this manner, the most frequent being diffuse histiocytic or diffuse, poorly differentiated, lymphocytic lymphoma. Only 18 cases of primary laryngeal non-Hodgkin's lymphoma have been reported so far in the English literature. We had under our care such a rare case of primary non-Hodgkin's lymphoma of the larynx and hence its presentation.
A 60 year old male was admitted to the Medical College and Hospital, Calcutta, in the month of November, 1984 for evaluation of a laryngeal mass. The patient gave history of hoarseness of voice for about 6 months. There was history of smoking of about 10 cigarettes per day. No history of weight loss, haemoptysis or night sweat was present. Indirect laryngoscopy revealed a left subglottic mass nearly obstructing the airway.
Remaining physical examinations were normal. Routine haemogram, liver function tests and X-ray chest were within normal limits. Tracheostomy and direct laryngoscopy revealed a subglottic mass arising from below the true left vocal cord. The mass was seen reaching upto the right side of the subglottic region resulting in almost complete occlusion of the lumen. The oropharynx, epiglottis and hypopharynx were normal. Both the vocal cords moved normally. Biopsy was taken from the growth.
Microscopic examination showed a lining of pseudostratified ciliated columnar epithelium. Extensive squamous metaplasia was present. The subepithelial zone was diffusely infiltrated by lymphocytes [Fig. 1] which had small rim of cytoplasm. The nuclei had coarse chromatin with prominent single nucleolus [Fig. 2]. No folicle with germinal centre was seen on serial sectioning. A diagnosis of a diffuse, poorly differentiated, lymphocytic lymphoma was made.
Bone marrow aspirations from the sternum and the liver and spleen scars were within normal limits. Radiotherapy was started from the seventh post-operative day, in the dose of 1900 rads to each side of the neck for 3 weeks. The growth subsided completely; a repeat biopsy was negative 4 months after radiotherapy. Tracheostomy was removed. The patient is still under follow-up.
Extranodal lymphomas originate not only at sites that normally contain lymphoid tissues such as small intestine and parotid gland but also in non-lymphoid tissue such as thyroid and stomach. Most primary laryngeal lymphomas probably develop in the lymphoid collections of the supraglottic lamina propria and laryngeal ventricles. Non-Hodgkin's lymphoma, limited solely to the larynx at the time of presentation, is extremely rare. Pseudolymphoma of the larynx is a rare lesion which may mimic lymphoma both grossly and microscopically.1 The distinction from true lymphoma is made histologically. In pseudolymphoma, there is a mixed cellular infiltrate composed of non-neoplastic lymphocytes, plasma cells, histiocytes and neutrophils. The presence of true germinal centres in pseudolymphoma is highly significant. Pseudolymphoma probably arises due to inflammatory stimulation.
Primary laryngeal lymphoma is a rare but potentially curable cause of upper airway obstruction. The age ranges from 14 to 81 years. Hoarseness of voice is the single, most frequent, presenting symptom, others being dysphonia, stridor, cough and weight loss. The disease tends to remain localised as evidenced by the presence of symptoms for a mean period of 10 months and the lack of recurrence in 16 of the 18 patients in whom local radiotherapy was employed. Radiotherapy appears to be the curative treatment of choice as evidenced by the excellent disease-free period of the 17 patients out of 19 cases including the present case being reported.
We are grateful to the Principal, Medical College and Hospital, Calcutta, and the Director, Thakurpukur Cancer Centre and Welfare Home, Calcutta for allowing us to publish the case report.
|1.||al-Saleem, T., Peale, A.R., Robbins, R. and Norris, C.M.: Lymphocytic pseudotumour (pseudolymphoma) of the larynx; Report of a rare case and review of literature. Laryngoscope, 80: 133-136, 1970. |
|2.||Gregor, R.T., Laryngeal malignant lymphoma: An entity?: J. Laryngol. Otol., 95: 81-94, 1981. |
|3.||Rudders, R.A., Ross, M.E. and De Lellis, R.A.: Primary extranodal lymphoma; response to treatment and factors influencing prognosis. Cancer, 42: 406-416, 1978 |
|4.||Swerdlow, J.B., Merl, S.A., Davey, F.R., Gacek, R.R. and Gottlieb, A.J.: Non-Hodgwin's lymphoma limited to the larynx. Cancer, 53: 2546-2549, 1984. |