Waldeyer's Ring Research Articles

Peripheral T-cell lymphoma with follicular helper of T cell phenotype of Waldeyer's ring: a clinicopathological and genetic study of eight cases

Objective: To study the clinicopathologic and genetic features of Waldeyer's ring peripheral T-cell lymphoma with follicular helper T cell immunophenotypes (wPTCL-TFH), with comparison to the nodal peripheral T-cell lymphoma with TFH immunophenotypes (nPTCL-TFH) and angioimmunoblastic T-cell lymphoma (AITL), as to know this rare tumor better. Methods: The clinical data, histopathology features, EBV positivity, T cell clonality and IDH2(R172) gene mutation in 8 cases of wPTCL-TFH were collected at the First Affiliated Hospital of Zhengzhou University from December 2015 to April 2019, and analyzed by immunohistochemistry, in situ hybridization, TCR gene rearrangement (BIOMED-2) and Sanger sequencing.Follow-up data were obtained by telephone. Results: There were 6 males and 2 females with a median age of 62.5 years (age ranging from 30 to 75 years). All patients had neither fever nor skin manifestations, but were all found mucosa thickened or mass of waldeyer's ring with multiple lymph nodes enlarged by PET-CT/CT scans. Five of the 7 patients were at advanced stages (Ⅲ/Ⅳ stage). Microscopically, the mucosa was infiltrated diffusely and characteristically by numerous small-medium sized lymphocytes, lacking polymorphous inflammatory background and extra-follicular expansion of follicular dendritic cell networks (FDC networks). The clear T cells presented in 5 cases. Ulcers on mucosal surfaces (6 cases) and local-extensive loss of intramucosal glands (7 cases) were commonly noted. Granulomas composed of epithelioid histiocytes were observed in 2 cases. Immunohistochemically, all the tumor cells expressed CD4 and at least 2 types of follicular helper of T cell (TFH) markers: PD-1 (8/8), bcl-6 (8/8), CXCL13 (7/8) and CD10 (1/8). Most of the cases (6 cases) expressed CD30. EBV positive appeared in 4 cases. All 8 cases were T cell monoclonal. IDH2(R172) were wild-type in 6 cases. One patient died at the follow-up time on 18 months; the other 7 survived (the follow-up time varied from 3 to 10 months). Conclusions: wPTCL-TFH is rare, and its clinicopathological features are similar to nPTCL-TFH which may be the manifestation of the same disease at different stage, and partly overlapped with AITL. The differential diagnosis from PTCL-NOS is necessary and comprehensive analyses of clinical, morphological, immunohistochemical and genetic features can help make a correct diagnosis.

Non-Hodgkin's Lymphoma of the Anterior Maxilla Mimicking a Chronic Apical Abscess

Non-Hodgkin lymphomas (NHLs) are malignant neoplasms of the lymphatic system, typically occurring in the fifth through seventh decades of life. Tumors develop from abnormal lymphocyte proliferation and accumulation. Although a majority of NHLs occur in nodal regions, 40% of cases appear in extranodal sites involving the stomach, spleen, Waldeyer's ring, central nervous system, lung, skin, and bone. Extranodal NHL presents a diagnostic challenge because it may mimic endodontic disease when occurring in intraosseous and soft tissue sites. This case report presents misdiagnosis of a diffuse large B-cell lymphoma (DLBCL) of the anterior maxilla in a 72-year-old man with a history of Waldenstrom's macroglobulinemia, where the lesion was thought to be associated with a necrotic pulp and a chronic apical abscess on tooth #7. Clinical findings of a facial sinus tract, a nonresponsive pulp, large periapical radiolucency, and history of trauma were in support of this diagnosis for tooth #7. On encountering vital pulpal tissues during cavity access of tooth #7, a cone-beam computed tomography scan and lesion biopsy were obtained. Through immunohistochemistry and histologic analysis, a diagnosis of DLBCL was made. During evaluation of lesions with suspected endodontic etiology, the clinician should consider all factors of the patient's health history, hereditary risk, and comprehensive clinical testing to attain a differential diagnosis. A nonodontogenic etiology of disease should always be considered unless ruled out otherwise. Atypical presentation or testing may prompt the need for biopsy and interspecialty assessment.

Normal FDG uptake in the adenoids and palatine tonsils in children on PET/MRI.

Information about the normal [F-18]2-fluoro-2-deoxyglucose (FDG) uptake in the adenoids and palatine tonsils in children is not available. The purpose of this study was to report the range of standardized uptake values (SUVs) in the normal adenoids and palatine tonsils in children, assess for the degree of asymmetry between the right and left tonsils and evaluate for the correlation of SUVs between the adenoids and tonsils. Pediatric patients who had had an FDG positron emission tomography (PET)/magnetic resonance imaging (MRI) brain study in our institution from January 2018 to March 2019 were identified. Patients with a history of malignancy, adenoidectomy and/or tonsillectomy, incomplete imaging coverage of Waldeyer ring and the presence of artifact on PET/MRI were excluded. Two pediatric radiologists independently measured the mean and maximum SUVs of the right tonsil, left tonsil and the adenoids. Range, mean and standard deviation were calculated for all measurements. Ratios of SUV of the left to right tonsils and the adenoids to the tonsils were calculated. The paired t-test and Pearson's correlation test were used for statistical analysis with a P-value <0.05 considered to be significant. Sixty-one PET/MRI brain scans were performed in our institution during the study period. After reviewing for exclusion criteria, 41 patients were included in the study (mean age: 10.1years, range: 2-17years; 19 boys and 22 girls). The mean SUV was 5.30±1.57 in the right tonsil, 5.25±1.53 in the left tonsil and 4.56±1.90 in the adenoids. The maximum SUV was 8.47±2.22 in the right tonsil, 8.45±2.18 in the left tonsil and 7.59±2.94 in the adenoids. The difference between the SUVs of the right and left tonsil was not statistically significant (P=0.69 for mean SUV and P=0.90 for maximum SUV). There was a statistically significant moderately positive correlation between the FDG uptake in the adenoids and the right and left tonsil for both mean and maximum SUV (r=0.36-0.41; P=0.008-0.022). There is a wide variation of FDG uptake in the normal tonsils and adenoids in children. Uptake in the right and left tonsils is not significantly different. There is a moderately positive correlation between the FDG uptake in the adenoids and the tonsils.

Diagnostics and treatment of adenotonsillar hyperplasia in children

Adenoidectomy, paracentesis, and tonsillar interventions are the most common operations in childhood. Hypertrophy of the lymphatic tissue of Waldeyer's ring can lead to individually distinct, acute, and chronic symptoms as well as anatomical and functional changes. When presented with affected children in otolaryngologic practice, the combination of parental interview, questionnaire-based screening for obstructive sleep apnea syndrome, and physical examination including ear microscopy, inspection of the oropharynx and, if necessary, the nasopharynx, has proven its worth. Audiometric diagnosis for detection of tympanic effusion should be mandatory. The treatment of choice is adenoidectomy, if necessary plus tonsillotomy and paracentesis with atympanic tube insert. However, the indication remains controversial, as the effectiveness of the interventions seems to depend on the preoperative severity of symptoms. With a correct indication, effective symptom reduction, improvement in quality of life, and high parent satisfaction can be expected.

18F-FDG PET/CT in the Diagnostic and Treatment Evaluation of Pediatric Posttransplant Lymphoproliferative Disorders.

We aimed to evaluate the diagnostic performance of 18F-FDG PET/CT for the detection of posttransplantation lymphoproliferative disorder (PTLD) in a pediatric population and explore its feasibility during response assessment. Methods: This retrospective study included 28 pediatric transplant recipients who underwent a total of 32 18F-FDG PET/CT scans due to clinical suspicion of PTLD within an 8-y period. Pathology reports and 2 y of follow-up were used as the reference standard. Twenty-one response assessment 18F-FDG PET/CT scans were reevaluated according to the Lugano criteria. Results: The diagnosis of PTLD was established in 14 patients (49%). Sensitivity, specificity, positive predictive value, and negative predictive value of 18F-FDG PET/CT for the detection of PTLD in children with a clinical suspicion of this disease were 50% (7/14), 100% (18/18), 100% (7/7), and 72% (18/25), respectively. False-negative results occurred in patients with PTLD in the Waldeyer's ring, cervical lymph nodes, or small bowel with either nondestructive or polymorphic PTLD. Two of 5 interim 18F-FDG PET/CT scans and 3 of 9 end-of-treatment 18F-FDG PET/CT scans were false-positive. Conclusion:18F-FDG PET/CT had good specificity and positive predictive value but low to moderate sensitivity and negative predictive value for the detection of PTLD in a 28-pediatric-patient cohort with a clinical suspicion of this disease. False-negative results were confirmed in the Waldeyer's ring, cervical lymph nodes, and small bowel with either nondestructive or polymorphic PTLD subtypes. 18F-FDG PET/CT appears to have a limited role in the response assessment setting of pediatric PTLD, given the observed high proportions of false-positives both at interim and at end-of-treatment evaluations.

Non-hodgkin's lymphoma at the base of tongue: A rare localization

The extra-nodal non-Hodgkin's lymphomas (NHLs) are mainly found in the head–and-neck region after the gastrointestinal tract. In the head–and-neck region, most common sites for NHL are Waldeyer's ring, followed by the sinonasal tract. NHL at the base of the tongue is extremely rare. The evaluation of the mass at the base of the tongue is a diagnostic challenge for a clinician as a wide spectrum of the benign and malignant lesions found in this site. The diagnosis of the NHL is established by histopathological and immunohistochemical studies. Here, we reported a case of the NHL at the base of the tongue in 28-year-old female. The patient was treated with three cycles of a combination of cyclophosphamide, vincristine, adriamycin, and prednisone chemotherapy and rituximab followed by radiotherapy. There was no evidence of recurrence during the first, second, and third years of the follow up period.

Non-Hodgkin's lymphoma: A review.

Lymphomas constitute the third most common neoplasm in head and neck region arising from the lymphoreticular system. Malignant lymphomas are divided into Hodgkin's disease and non-Hodgkin's lymphoma (NHL). NHL comprises approximately 5% of head and neck malignancies and displays a wide range of appearances comparable with Hodgkin's disease. Hodgkin's and non-Hodgkin's lymphomas are seen in the head and neck region, but extranodal disease, with or without lymph node involvement, is more common among NHL patients. Extranodal involvement includes the areas such as Waldeyer's ring (i.e., the tonsils, pharynx, and base of the tongue), salivary glands, orbit, paranasal sinuses, and thyroid glands. There are several classification systems for categorizing NHL out of which WHO classification for lymphoid neoplasms is mostly followed. This review describes the pathogenesis of NHL and explains some of the important NHL (Marginal zone B-cell Lymphoma, follicular lymphoma, mantle cell lymphoma).

Clinicopathologic features and prognostic analysis of Waldeyer ring B-cell lymphoma

This retrospective study is to explore the clinicopathologic, immunophenotypic, and molecular genetic features of Waldeyer ring B-cell lymphoma (WR-BCL).Tissue arrays from 65 WR-BCL cases were subjected to pathologic and immunophenotypic detections. Expression of Epstein–Barr virus-encoded small RNA (EBER) was detected by in situ hybridization. Interferon regulatory factor 4 (IRF4), BCL-2, BCL-6, and C-myelocytomatosis viral oncogeneav (MYC) gene abnormalities were investigated using interphase fluorescence in situ hybridization.Among the 65 patients, there were 12 nasopharynx cases, 49 tonsil cases, and 4 tongue root cases. Moreover, there were 49 cases of diffuse large BCL (DLBCL) and 16 cases of follicular lymphoma (FL). More than 60% of the patients had Ann Arbor stage III/IV disease, with infiltrated neighboring organs, invaded spleens, and increased lactate dehydrogenase (LDH) levels. Tumor cells were positive for multiple myeloma antigen 1 (MUM1), BCL-2, BCL-6, and C-MYC. EBER expression was detected in lymphoma cells of 2 cases. Alteration frequencies of IRF4, BCL-2, BCL-6, and C-MYC were 24.6%, 32.3%, 27.7%, and 30.7%, respectively. Approximately 67.69% cases had stages 0 to II disease, while 32.31% cases had stage III disease. Five-year overall survival rate was 65.12%. Eastern Cooperative Oncology Group performance status (ECOG) score ≥2 was the only adverse factor for overall survival. IRF4/MUM1, C-MYC, and CD10 expressions were related to poor disease prognosis. WR-BCLs were largely dependent on ECOG, LDH, and bone marrow involvement. WR-DLBCL was associated with poor survival outcomes compared with WR-FL.The WR-DLBCLs have distinct clinicopathologic features, with correlations between the IRF4/MUM1, C-MYC and CD10 expressions, ECOG, LDH, bone marrow involvement, and the disease prognosis.

Mantle Cell Lymphoma of Mucosa-Associated Lymphoid Tissue: A European Mantle Cell Lymphoma Network Study.

While classical nodal mantle cell lymphoma (cMCL) is often associated with involvement of multiple extranodal sites, isolated extranodal disease (ED) at the time of diagnosis is a rare event; data on the outcome of these forms are lacking. On behalf of the European MCL Network, we conducted a retrospective analysis on the clinical characteristics and outcomes of MCL presenting with isolated or predominant ED (MALT MCL). We collected data on 127 patients with MALT MCL diagnosed from 1998 to 2015: 78 patients (61%) were male with a median age of 65 years. The involved sites include: upper airways + Waldeyer ring (40; 32%), gastrointestinal tract (32; 25%), ocular adnexa (17; 13%), oral cavity and salivary glands (17; 13%) and others (13; 1%); 7 patients showed multiple extranodal sites. The median follow-up was 80 months (range: 6-182), 5-year progression-free survival (PFS) was 45% (95% CI: 35-54) and 5-year overall survival (OS) was 71% (95% CI: 62-79). In an explorative setting, we compared MALT MCL with a group of 128 cMCL patients: MALT MCL patients showed a significantly longer PFS and OS compared with nodal cMCL; with a median PFS of 4.5 years vs 2.8 years (p = 0.001) and median OS of 9.8 years vs 6.9 years (p = 0.018), respectively. Patients with MALT MCL at diagnosis showed a more favorable prognosis and indolent course than classical nodal type. This clinical variant of MCL should be acknowledged to avoid possible over-treatment.

DIFFUSE LARGE B-CELL LYMPHOMA OF ACTIVATED B-CELL-LIKE SUBGROUP AFFECTING THE PALATE

Diffuse large B-cell lymphoma (DLBCL) is a non-Hodgkin lymphoma subtype constituted by diffuse proliferation of large neoplastic cells. The most commonly affected site in the head and neck is the Waldeyer ring, often involving adult and elderly patients. The World Health Organization classification recognizes germinal center B-cell–like and activated B-cell–like (ABC) molecular DLBCL subgroups, which differ in chromosomal alterations and clinical outcome. A 93-year-old female patient presented with an ulcer on the palate with 30 days of evolution and cervical mass rapidly growing in the last 15 days. An incisional biopsy was performed, and microscopic analysis revealed a DLBCL of ABC subgroup, showing immunopositivity for CD20, CD79 a, BCL-6, MUM-1, and BCL-2, and Ki67 was > 80%. She was submitted to palliative chemotherapy; however, she died 6 months later. DLBCL, especially the ABC subgroup, can follow an aggressive clinical course. Thus, early recognition is important to institute appropriate treatment with impact on prognosis. Diffuse large B-cell lymphoma (DLBCL) is a non-Hodgkin lymphoma subtype constituted by diffuse proliferation of large neoplastic cells. The most commonly affected site in the head and neck is the Waldeyer ring, often involving adult and elderly patients. The World Health Organization classification recognizes germinal center B-cell–like and activated B-cell–like (ABC) molecular DLBCL subgroups, which differ in chromosomal alterations and clinical outcome. A 93-year-old female patient presented with an ulcer on the palate with 30 days of evolution and cervical mass rapidly growing in the last 15 days. An incisional biopsy was performed, and microscopic analysis revealed a DLBCL of ABC subgroup, showing immunopositivity for CD20, CD79 a, BCL-6, MUM-1, and BCL-2, and Ki67 was > 80%. She was submitted to palliative chemotherapy; however, she died 6 months later. DLBCL, especially the ABC subgroup, can follow an aggressive clinical course. Thus, early recognition is important to institute appropriate treatment with impact on prognosis.

Histological characterization of the lingual tonsils of the one-humped camel (Camelus dromedarius).

Tonsils are located in the entrance of digestive and respiratory tracts forming Waldeyer's ring that reacts against ingested or inhaled antigens. On occasion, tonsils may be a site of entry and replication for some pathogens. The lingual tonsils are a main constituent of the Waldeyer's ring. Despite the immunological importance of the lingual tonsils, there is limited information about their structure in the one-humped camel. The lingual tonsils of 10 clinically healthy male camels (3-25 years) were collected and studied macroscopically and microscopically. Lingual tonsils were localized at the root of the tongue of camels of all ages in the form of several spherical macroscopic nodules protruding into the oropharynx. Each nodule possesses a single central crypt, covered with keratinized stratified squamous epithelium without any M cells and surrounded with an incomplete capsule. Each tonsillar crypt was lined with stratified squamous non-keratinized epithelium with lymphocytic infiltration forming patches of lymphoepithelium or reticular epithelium. Secondary lymphoid nodules extended under the apical epithelium. The interfollicular areas had diffused lymphocytes. Among these lymphocytes, high endothelial venules, macrophages, dendritic cells and plasma cells were observed. The organization of camel lingual tonsils in isolated units with separate crypts increases the surface area exposed to antigen. The present findings indicate a sustained immunological role of the lingual tonsils throughout the life of the one-humped camel.

Extranodal manifestation of classical Hodgkin lymphoma in the head and neck region

Extranodal lymphomas occurring in the head and neck region account for 12-15% of all malignant tumors of this locality. Classical Hodgkin lymphoma (cHL) is arare subtype, representing around 1% of all lymphomas in Waldeyer's ring. Cases diagnosed in the Reference Centre for Lymph Node Pathology at the Pathological Institute of the University of Würzburg were further analyzed in this study. Histological subtype and EBV association of 21cases were reviewed in conjunction with clinical data. Data of 12male and 9female patients with an average age of 51years (median 45; 35-72) were reviewed. All samples were taken from the lymphatic tissue of the Waldeyer's ring (nasopharynx n = 15, palatine tonsils n = 5, lingual tonsils n = 1). The most common symptoms leading to aconsultation with an otorhinolaryngologist were otalgia, swelling, or impaired nasal breathing. Only four patients showed typical B‑symptoms. In 6cases (29%), an isolated extranodal manifestation was found, 15patients (71%) showed simultaneous infiltration of cervical lymph nodes during staging, and 6cases (29%) were EBV positive. An exclusively extranodal manifestation of cHL in Waldeyer's ring is rare, whereas infiltration of extranodal tissue in the case of aprimary manifestation of lymphoma in cervical nodes can occur more frequently and may often remain undiagnosed. Therefore, aspecialized ENT consultation could be areasonable complementary module in tumor staging to determine the correct tumor extent.

Simultaneous Integrated Boost IMRT with Three Dose Gradients in Patients with Stage I-II Nasal Cavity and Waldeyer's Ring Natural Killer/T-Cell Lymphoma: A Prospective Phase II Clinical Trial

Simultaneous Integrated Boost IMRT with Three Dose Gradients in Patients with Stage I-II Nasal Cavity and Waldeyer's Ring Natural Killer/T-Cell Lymphoma: A Prospective Phase II Clinical Trial

Primary Extranodal Nodular Lymphocyte Predominant Hodgkin Lymphoma Involving the Thyroid

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is an uncommon lymphoma that accounts for 3-8% of all Hodgkin lymphomas. NLPHL typically presents as early stage disease with localized peripheral lymphadenopathy. Involvement of extranodal sites at the time of presentation occurs in 6% of cases and most commonly involves the spleen, liver, bone marrow, and Waldeyer ring. Primary extranodal NLPHL is exceedingly rare. We describe the first reported case involving the thyroid and review the six other previously described cases of primary extranodal NLPHL.

Rare mature B‐cell lymphomas in children and adolescents

Pediatric-type follicular lymphoma (PTFL), pediatric nodal marginal zone lymphoma (pnMZL), and large B-cell lymphoma (LBCL) with IRF4 rearrangement have been introduced into the current World Health Organization (WHO) classification. They account for 5% to 10% of mature B-cell lymphomas in children and adolescents. Both PTFL and pnMZL predominantly affect male adolescents and usually present with localized lymphadenopathy in the head and neck region. The cells within the follicles of PTFL typically show high-grade cytology, IGH monoclonality and lack the t(14;18) chromosomal alteration. In contrast, pnMZL is characterized by progressive transformation of germinal center (PTGC)-like features and interfollicular proliferation of the cells with expansion of the marginal zones with diffuse areas. Watch and wait after complete resection seems an adequate therapy with chemotherapy restricted to incompletely resected disease. All children with PTFL and pnMZL reported, so far, survived. B-cell lymphomas presenting in the Waldeyer's ring are characterized by the expression of IRF4/MUM1 and often associated with IRF4 rearrangements. Because of the frequent diffuse component, treatment often follows current protocols for mature B-NHL. The prognosis is excellent.

PROSPECTIVE STUDY OF 3T WHOLE BODY DIFFUSION WEIGHTED MAGNETIC RESONANCE (WB DWI MRI) COMPARED TO PET IN STAGING AND ASSESSMENT OF TREATMENT RESPONSE IN FDG AVID LYMPHOMAS

Introduction: PET is considered the gold standard for staging and evaluation of treatment response in FDG avid Lymphoma. 3T WB-DWI-MRI may represent an option for detection and better characterisation of tumoral lesions without use of FDG or iodated/paramagnetic contrast medium. We compared 3T WB-DWI-MRI with PET in the evaluation of Hodgkin lymphoma (HL) and Diffuse large cell lymphoma patients (DLBCL). Methods: From may 2016, 25 patients (14 cases of HL and 11 cases of DLBCL) were diagnosed at our institution. PET and 3T WB-DWI-MRI was perfomed at diagnosis and post treatment for a total of 118 nodal sites and 21 extranodal valued sites. DWI imaging was obtained with multi shot sequences (thickness 4 mm) multi-b (b-value: 0, 150, 1000) and ADC cut off value 1.2 for functional evaluation. Morphological images were obtained by using sequences fast spin-echo short time inversion recovery (STIR with thickness 4mm) and Turbo spin-echo (T2-TSE with thickness 4mm) and sequnces T1-FAST-Field-echo (T1-FFE) in and out - phase (thickness 4mm). MRI were compared with PET imaging performed at the same time and assessed blind by radiologist and Nuclear Medicine physician. Results: The 3T WB-DWI-MRI and PET results were concordant at the diagnosis after evaluation of 118 nodal site and 21 extra nodal site with Cohen's Kappa coefficient showed agreement to be excellent (K = 0.82 and 0.84 respectively). When performed after treatment the two methods were not concordant due to the greater sensitivity and specificity of the RMI (high positive and negative predictive value. In 5/25 cases of nodal site and in 2/16 cases of extra nodal site after chemotherapy MRI and PET results were discordant and PET failed complete remission finding (doubts residues after therapy not confirmed at subsequent follow-up). Conclusions: These data suggest that 3T WB-DWI-MRI can be considered a sensitive and specific method for assessing treatment response in Lymphoma without the use of ionising radiation or administration of F-18 Flurodeoxyglucose. In this population, MRI appears to obtain a better definition of the response after chemotherapy especially in mediastinal, hepatic, waldeyer ring and bone sites. Further studies are needed to evaluate the optimum ADC values in assessing treatment response in a more large number of patients. Keywords: diffuse large B-cell lymphoma (DLBCL); Hodgkin lymphoma (HL); positron emission tomography (PET).

Cystic cervical lymph nodes metastasis revealing a papillary carcinoma of the thyroid gland: A case report

Cystic cervical lymph nodes are a rare anatomo-clinical form. They are a typical presentation of metastasis of cancers of the waldeyer ring in particular those of the palatine tonsil. Nevertheless,

LINFOMA EXTRAGANGLIONAR EN RINOFARINGE: A PROPÓSITO DE UN CASO

Introduction: Non-Hodgkin lymphoma (NHL) can develop in extranodal areas more frequently than Hodgkin lymphoma, 60% of cases versus 2% in LH. 60% of the extranodal regions are limited to head and neck. Extranodal lymphoma originates in different organs than lymph node. Areas rich in lymphoid tissue, such as Waldeyer's ring, represent more than half of the cases; Other locations of greater to lower frequency may be the orbits, salivary glands, thyroid, nasal and paranasal pits and larynx. Case report: A 82-year-old woman was followed up by Hematology for 5 years for Chronic Lymphatic Leukemia. During Dacryocystorhinostomy a lesion on the roof of the left nasal pit was found, which was biopsied, resulting an infiltration by lymphocytes suggestive of lymphoproliferative process. Six months later she came for sudden bilateral loss of hearing. During the examination, a large cavum mass was evidenced, confirmed by a cervico-facial CT, which reflects an asymmetry with slight diffuse thickening of the nasopharynx, mainly on the left side, poorly delimited, without bone destruction of the base of the skull. It also presents submandibular and laterocervical adenopathies of up to 1.1 cm, larger in levels IA and IIB. A biopsy is taken. Results: The anatomopathological report of the sample suggests the presence of a lymphoproliferative process with lymphocytes of small to medium size, with anisocytosis and slightly irregular nuclei, some of them with cleft. They express CD5 and CD20, and are negative for CD10, Cyclin D1 and SOX-11. MALT-1 is negative. Ki-67 is positive in 25% of the cells. It can not be completely ruled out that it is a MALT lymphoma with CD5 expression (uncommon or exceptional in lymphomas of mucosal-associated lymphoid tissue). However, the morphology of the lesion and the clinical history of the patient are more typical of a Mantle Cell lymphoma (CD5 positive), although Cyclin-D1 and SOx-11 have been negative, which is also possible but not frequent in this type of lymphomas. Given the discrepancy in the diagnosis, HISS t (4:14) of mantle lymphoma and chemotherapy with R-Bendamustine was started. Conclusions: Extranodal lymphomas in the head and neck are mainly non-Hodgkin lymphomas. The Waldeyer's Ring is the most frequent location in the head and neck area, representing more than half of the extra-ganglionic lymphomas in this area, which according to some authors reaches 10% of all lymphomas. Imaging tests are a great help for diagnosis and staging. In the presence of homogeneous lymph nodes with lesions in Waldeyer's ring, suspect lymphoma. The use of special techniques of immunohistochemistry and electron microscopy is essential for its differential diagnosis. In most cases, a systemic treatment with chemotherapy will be chosen.

The correlation between adenoid hypertrophy and allergic rhinitis

Adenoid tissue are the major constituent of Waldeyer's ring which are physiologically natural defense mechanism of the body against inhaled allergens and microorganisms.In all children, the volume of the adenoid increases with age with a maximal volume in the age group of 5-6 years, followed by a gradual decrease in volume by the age of 8-9 years.Allergic rhinitis is a non-infectious chronic inflammatory disease of nasal mucosa mediated by immunoglobulin E and involved by a variety of immunocompetent cells (T, B lymphocytes, mast cells, etc.) after atopic individual contact with allergens.Adenoid hypertrophy and allergic rhinitis are common and frequently-occurring diseases in children. Both of them may exist simultaneously and may cause similar clinical symptoms. This paper reviews the relationship between adenoid hypertrophy and allergic rhinitis.

Diffusion-weighted Magnetic Resonance Imaging in Odontogenic Keratocysts: Preliminary Study on Usefulness of Apparent Diffusion Coefficient Maps for Characterization of Normal Structures and Lesions.

To investigate the usefulness of diffusion-weighted magnetic resonance imaging (DWI) in odontogenic keratocysts, especially apparent diffusion coefficient (ADC) maps for the characterisation of normal structures and cystic lesions in the jaw. Sixteen patients who underwent magnetic resonance imaging (MRI) for the diagnosis of a cystic lesion in the jaw were included in this prospective study. DWI was performed on a 1.5 T unit with b factor of 0 and 800 s/mm2, and ADC maps were generated. ADC values were measured for the normal structures in the upper neck area and for the cystic lesion in the jaw. The mean ADC value of the cerebrospinal fluid (3.66 ± 0.47 × 10-3 mm2/s) in the upper neck area was higher than that of the nasal mucosa (1.80 ± 0.19 × 10-3 mm2/s), Waldeyer's ring (0.75 ± 0.11 × 10-3 mm2/s) and the spinal cord (0.71 ± 0.20 × 10-3 mm2/s). The mean ADC value of the five odontogenic keratocysts (1.03 ± 0.31 × 10-3 mm2/s) was lower than that of the one simple bone cyst (2.79 × 10-3 mm2/s), three nasopalatine duct cysts (2.28 ± 0.12 × 10-3 mm2/s), three radicular cysts (1.82 ± 0.71 × 10-3 mm2/s) and four dentigerous cysts (1.67 ± 1.06 × 10-3 mm2/s). This study suggested the usefulness of DWI in odontogenic keratocysts, especially ADC maps for the characterization of normal structures and cystic lesions in the jaw.