Hematolymphoid Tumors of the Head and Neck

Abstract

Hematolymphoid tumors represent a primarily, but not exclusively, malignant cohort of tumors that are commonly diagnosed in the head and neck. These neoplasms include the T-cell lymphoproliferative disorder, extranodal natural killer and T-cell lymphoma, extraosseous plasmacytoma, diffuse large B-cell lymphoma, classic Hodgkin lymphoma, nodular lymphocyte predominant Hodgkin lymphoma, Burkitt lymphoma, follicular lymphoma, mantle cell lymphoma, T-lymphoblastic leukemia and lymphoma, extranodal marginal (mucosa-associated lymphoid tissue [MALT]) lymphoma, follicular dendritic cell sarcoma, plasmablastic lymphoma, Langerhans cell histiocytosis, and extramedullary myeloid sarcoma. Collectively, these tumors represent a very heterogeneous group of neoplasms that should be considered when establishing a differential diagnosis of a mass of the oral or oropharyngeal mucosa, cervical lymph nodes, and jaws. As a once microscopically elusive subset of tumors, contemporary molecular techniques and a greater intellectual understanding of these tumors have resulted in more expedient diagnosis of this fascinating group of neoplasms. 1.Brown NA, Elenitoba-Johnson KSJ: Update from the 4th edition of the World Health Organization Classification of Head and Neck Tumours: Hematolymphoid tumours. Head Neck Pathol 11:96, 2017. http://link.springer.com/article/10.1007%2Fs12105-017-0802-5 This article discusses changes in the classification of hematolymphoid neoplasms of the head and neck since the 2005 World Health Organization classification and recent advances in the understanding of the pathogenesis and molecular pathology of these tumors. This article was published in advance of the release of the latest revision of the World Health Organization Classification of Head and Neck Tumours. 2.Allin D, David S, Jacob A, et al: Use of core biopsy in diagnosing cervical lymphadenopathy: A viable alternative to surgical excisional biopsy of lymph nodes? Ann R Coll Surg Engl 99:242, 2017. http://publishing.rcseng.ac.uk/doi/full/10.1308/rcsann.2016.0353 Time-honored guidelines for diagnosis of lymphoma typically require that lymph node excision be performed to obtain ample tissue to permit full nodal architecture so as to reach an accurate histologic classification. This retrospective analysis was performed of 70 patients with cervical lymphadenopathy who underwent ultrasound-guided core rather than excisional biopsy examinations. The final pathology report was scrutinized to determine whether adequate tissue was procured to establish a definitive diagnosis. Of the 70 patients' core biopsy examinations, 63 (90%) were diagnostic for lymphoma or other pathology and did not require further sampling of tissue. Overall, 19 patients were diagnosed with lymphoma and only 1 patient required additional tissue sampling to establish the diagnosis of lymphoma after inconclusive initial biopsy results. 3.Silva TDB, Ferreira CBT, Leite GB: Oral manifestations of lymphoma: A systematic review. Ecancermedicalscience 10:665, 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4990057/ This review identified oral manifestations of lymphoma through a systematic literature review that was conducted using the PubMed, Lilacs, Embase, and Cochrane Library databases. The investigators found 1,456 articles from which they selected 73. A total of 982 cases of lymphoma were reported in these 73 publications, including 76 patients described in case reports and 906 patients described in retrospective studies. The most frequent oral manifestations of lymphoma were noted to be ulcerations, swelling, and tooth mobility. The most common extraoral findings included facial asymmetry and cervical lymphadenopathy. 4.Chen LY, Tsai MH, Tsai LT, et al: Primary Sjögren's syndrome initially presenting as submandibular mucosa-associated lymphoid tissue lymphoma: A case report. Oncol Lett 11:921, 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4734050/ This report reviewed the case of a 24-year-old patient with a nontender submandibular mass of 3 months' duration. A clinical diagnosis of sialadenitis was offered and the patient underwent computerized tomography. The patient underwent removal of the submandibular gland and a microscopic diagnosis of extranodal low-grade marginal zone B-cell (MALT) lymphoma was established. The investigators stressed that, although uncommon, lymphoma should be part of the differential diagnosis in patients who present with a single submandibular gland swelling. 5.Huong G, Olson LC, Rippis GE, et al: An index case of cutaneous Hodgkin lymphoma and review of the literature. Am J Dermatopathol 38:739, 2016. https://www.ncbi.nlm.nih.gov/pubmed/26959698 Although a common lymphoid malignancy, Hodgkin lymphoma presents as a primary cutaneous tumor in extraordinarily rare instances. In fact, Hodgkin lymphoma is the rarest of all lymphomas involving the skin, with involvement in only 0.5 to 7.5% of all patients with Hodgkin lymphoma. An unusual case of classic Hodgkin lymphoma of the scalp is presented in a 76-year-old patient with an underlying history of metastatic breast cancer. The investigators indicated that to establish the diagnosis of primary cutaneous Hodgkin lymphoma, a case must conform to strict criteria, including being defined by the presence of Hodgkin lymphoma in the skin without nodal involvement and no evidence of extracutaneous dissemination 3 months after diagnosis. 6.Alli N, Meer S: Head and neck lymphomas: A 20-year review in an oral pathology unit, Johannesburg, South Africa, a country with the highest global incidence of HIV/AIDS. Oral Oncol 67:17, 2017. http://www.oraloncology.com/article/S1368-8375(17)30019-2/pdf This article provided a retrospective review of the frequency and clinicopathologic characteristics of patients diagnosed with head and neck lymphoma at the Oral Pathology Department at the University of Witwatersrand from 1993 through 2012. A total of 504 patients with head and neck lymphomas were identified. The cervical lymph nodes were the most common anatomic site involved (115 cases) and the maxilla (60 cases) was the most common extranodal site. Plasmablastic lymphoma (159 cases) was the most common histologic subtype, likely because of its strong association with the human immunodeficiency virus and the acquired immunodeficiency syndrome. The investigators concluded an increased incidence in head and neck lymphoma during their 20-year period of study in their defined South African population. 7.Triantafillidou K, Dimitrakopoulos J, Iordanidis F, et al: Extranodal non-Hodgkin lymphomas of the oral cavity and maxillofacial region: A clinical study of 58 cases and review of the literature. J Oral Maxillofac Surg 70:2776, 2012. http://www.joms.org/article/S0278-2391(12)00122-X/fulltext This study reviewed 58 patients with extranodal non-Hodgkin lymphomas of the oral and maxillofacial region. The most frequent sites of occurrence were the salivary glands (24 patients) and the oral mucosa (21 patients). Two cases involved the maxillary bone and 1 case involved the mandibular bone. The histologic subtypes were extranodal marginal zone lymphoma (MALT) in 21 patients and diffuse large B-cell lymphoma in 19 patients. More favorable survival was noted for patients with MALT lymphomas than for those with diffuse large B-cell lymphomas. 8.Laviv A, Sohani AR, Troulis MJ: Lymphoma mimics obstructive sialadenitis: Three cases. J Oral Maxillofac Surg 72:1325.e1, 2014. http://www.joms.org/article/S0278-2391(14)00241-9/pdf These investigators reviewed 3 cases of low-grade follicular lymphoma that mimicked obstructive sialadenitis among a total of 591 patients with obstructive sialadenitis evaluated at their hospital from 2009 through 2012. These 3 patients included 1 with radiographic evidence of submandibular sialolithiasis, 1 with sublingual gland enlargement, and 1 with a mass in the floor of the mouth. The investigators stressed that tumor should be considered in patients with obstructive sialadenitis when the symptoms or clinical findings are not typical or do not resolve. 9.Picard A, Cardinne C, Denoux Y, et al: Extranodal lymphoma of the head and neck: A 67-case series. Eur Ann Otorhinolaryngol Head Neck Dis 132:71, 2015. http://www.sciencedirect.com/science/article/pii/S1879729614001719 This single-center retrospective observational study investigated 67 cases of extranodal lymphoma of the head and neck from 2001 through 2013. There were 56 cases of B-cell lymphoma, including 36 cases of diffuse large B-cell lymphoma and 6 cases of MALT B-cell lymphoma. There were no cases of Hodgkin lymphoma in this series. The most common sites of extranodal lymphoma were located in the palatine tonsil (n = 19), nasal fossa and sinus (n = 13), nasopharynx (n = 10), and parotid gland (n = 9). Presenting symptoms included a mass (n = 22), B symptoms (n = 6), and pain (n = 4). Diagnosis was established through a partial or total organ specimen in 36 cases and an incisional biopsy specimen in 31 cases. Fine needle aspiration biopsy examination was possible in only 46% of cases and performed in 24% of cases. Cytology diagnosed lymphoma in 31% of cases, was equivocal in 44% of cases, and non-contributive in 25% of cases. 10.Etemad-Moghadam S, Tirgary F, Keshavarz S, et al: Head and neck non-Hodgkin's lymphoma: A 20-year demographic study of 381 cases. Int J Oral Maxillofac Surg 39:869, 2010. http://www.ijoms.com/article/S0901-5027(10)00223-7/abstract This study reviewed the records of approximately 80,000 patients referred to the cancer institute at the investigators' institution, of which 453 patients had been diagnosed with non-Hodgkin lymphoma. After exclusion owing to incomplete records, 381 patients composed the study. Of the 381 cases of extranodal lymphoma, 281 patients had nodal disease and 100 patients had primary extranodal non-Hodgkin lymphoma. Of the extranodal lymphomas, 22 cases were identified in the tonsils, 13 in the nasopharynx, 15 in the parotid gland, and 11 in the submandibular gland. Sixteen cases were located in the jaws and 4 and 9 cases were located in the maxilla and mandible, respectively. The most common clinical presentations observed in these 381 patients were swelling and lymphadenopathy, which were noted in 378 and 240 patients, respectively. For nodal and extranodal lymphomas, intermediate-grade lymphomas were most commonly diagnosed, accounting for 69 and 206 patients, respectively.