Malignant lymphoma of Waldeyer's ring.

Abstract

Malignant lymphomas, other than Hodgkin's disease, often have been considered incurable and commonly are approached pessimistically with radiation therapy of palliative intent. Experience has shown that extranodal malignant lymphomas, such as primary reticulum-cell sarcoma of bone and gastrointestinal tract, are in fact radiocurable; and in the early stage of the disease, the five-year survival is quite good after aggressive radiation therapy (1–6). The faucial, nasopharyngeal, and lingual lymphoid tonsils constitute the so-called Waldeyer's ring. A malignant lymphoma arising primarily from these sites presents certain interesting clinical and radiotherapeutic features. The purpose of this paper is to present a study of 75 patients with such disease who were seen and treated at the Massachusetts General Hospital and Massachusetts Eye and Ear Infirmary from 1941 to 1967 inclusive. The disease was histologically proved in each case, and the follow-up information was complete. Those patients having preexisting generalized malignant lymphoma with secondary involvement of the Waldeyer's ring were not included. Material Of a total of 75 patients, 40 had involvement principally of the faucial tonsil, 23 of the nasopharyngeal tonsil, and 12 of the lingual tonsil. The records of these patients were reviewed, and the lesions were separated into stages according to the extent of the disease. The classification proposed by Peters (5) was used. In Stage I the lesions are limited to the primary site of the Waldeyer's ring, and in Stage II to the primary site with involvement of the adjacent lymphatic region. Stage III indicates the presence of generalized involvement. Of this group, 34 patients had Stage I, 28 Stage II, and 13 Stage III disease. Malignant lymphoma of Waldeyer's ring is predominantly a disease of the middleaged and the elderly. Approximately two-thirds of the patients were between the sixth and eighth decades of life, although ages in the group ranged from the teens to the eighties. In contrast to squamous-cell carcinoma of the head and neck, lymphoma occurs relatively more often in the female, but the male-to-female ratio in this study was 1.8: 1 (Table I). Clinically, malignant lymphoma of Waldeyer's ring varies in its growth appearance. Most of the tumors tend to be exophytic, smooth, submucosal, fleshy, and nonulcerative. A few, however, may be indistinguishable from ulcerative squamous- cell carcinoma. The local lesions are often extensive and become large and massive. At times the exact site of origin from the Waldeyer's ring can be determined only with great difficulty. Approximately 50 per cent of 40 patients with faucial lymphoma and 40 per cent of 12 patients with lingual lymphoma had massive lesions with involvement of multiple structures.