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Nasopharyngeal non-Hodgkin lymphoma

Case contributed by Ian Bickle
Diagnosis certain

Presentation

Referral to ENT from GP following concerns of a nasopharyngeal carcinoma.

Patient Data

Age: 65 years old
Gender: Female

Large bilateral nasopharyngeal mass extending, more so on the left, into the oropharynx.

Histology - NASOPHARYNGEAL BIOPSY

The biopsy shows a malignant lymphoma composed of sheets of atypical lymphoid cells infiltrating the fibrous and vascularized connective tissue stroma. The cells exhibit enlarged nuclei wih abnormal chromatin, some with prominent nucleoli ans scanty neoplasm.

The cells are strongly positive for LCA,CD20cy, CD79a.

Conclusion:  Malignant non-hodgkin lymphoma - B cell type

Case Discussion

The vast majority of nasopharyngeal masses are squamous cells carcinomas. The second commonest cause, albeit infrequent, cause of a primary nasopharyngeal malignancy is lymphoma.

Symmetrical lymphoid tissue normally exists in the nasopharynx, as Waldeyer's ring, in which a primary lymphoma may develop. Other sites in the locality include the tonsils.

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