Unusual Behavior of Primary Tonsillary Lymphoma
To the Editor: Primary tonsillary lymphoma accounts for less than 1% of head and neck malignancies. Tonsillectomy is used to mainly establish the diagnosis and can be performed for localized small lesions. In general, the patients are treated by chemotherapy and/or radiotherapy [1,2].
We present a 23-year-old woman who was referred to our ENT clinic with asymmetric tonsillary enlargement and acute bleeding. Tonsillectomy was performed. In paraffin sections; a tumor composed of large lymphoid cells that were positive for CD20, bcl-2, and p53 by immunohistochemistry was identified. Ki-67 index was roughly 80% (Figure 1). Polymerase chain reaction for immunoglobulin gene rearrangements was performed using DNA extracted from paraffin-embedded tissue and showed a single band indicating the presence of a clonal B cell proliferation. A diagnosis of ''Diffuse Large B Cell Lymphoma'' was rendered. No clinical or radiological evidence for tumor involvement in any other site was identified and the patient was accepted as Stage I clinically. The patient did not accept any further treatment. The patient was followed periodically every 6 months. Recurrence or systemic involvement was not observed during the 5-year-follow-up.
This case is unusual since only tonsillectomy was curative. In general, radiation therapy is considered the primary mode of therapy for localized disease in tonsil lymphomas (stages I and II) [3,4]. In one study, Jelic et al. reported a cure rate of 80% among their stage I NHL patients, who they followed without any therapy. In light of their experience as well as our observation, therapy options for localized NHL cases should be re-evaluated.