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

Abstract

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.