Abstract
BackgroundMost lymphomas that involve the tonsil are large B cell lymphomas. Large B-cell lymphoma is a high grade malignancy which progresses rapidly. Tonsillar lymphoma usually presents as either a unilaterally enlarged palatine tonsil or as an ulcerative and fungating lesion over the tonsillar area. Small lymphocytic lymphomas (SLL) of the Waldeyer's ring are uncommon.Case presentationWe report a 41-year-old male who presented with a ten-year history of snoring. Physical examination revealed smooth bilateral symmetrically enlarged tonsils without abnormal surface change or cervical lymphadenopathy. Palatal redundancy and a narrowed oropharyngeal airway were also noted. The respiratory disturbance index (RDI) was 66 per hour, and severe obstruction sleep apnea (OSA) was suspected. No B symptoms, sore throat, odynophagia or dysphagia was found. We performed uvulopalatopharyngoplasty (UPPP) and pathological examination revealed incidental small B-cell lymphocytic lymphoma (SLL).ConclusionIt is uncommon for lymphoma to initially present as OSA. SLL is an indolent malignancy and is not easy to detect in the early stage. We conclude that SLL may be a contributing factor of OSA in the present case.
Highlights
Most lymphomas that involve the tonsil are large B cell lymphomas
We report here a patient with severe obstructive sleep apnea treated by uvulopalatopharyngoplasty (UPPP)
Tonsillar surgery should be performed even on patients highly suspected of having lymphoma to improve obstruction sleep apnea (OSA) [810]
Summary
Adenotonsillar enlargement is the main cause of obstructive sleep apnea (OSA) in the pediatric population. This prevalent syndrome is more complicated in adults [1]. A series of careful examinations of the upper airway should be performed in every adult patient to check for anatomic causes related to upper airway obstruction [2]. We report here a patient with severe obstructive sleep apnea treated by uvulopalatopharyngoplasty (UPPP). PSG performed 4 months after surgery demonstrated that the RDI had reduced to 23.9/h. The patient was free from B symptoms and no further abnormal lymphadenopathy was detected even after head and neck computed tomography (CT) and thallium scan (figure 3). The patient is doing well and is on regular follow-up in the ENT and oncology clinics
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