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  Table of Contents  
LETTER TO THE EDITOR
Year : 2015  |  Volume : 52  |  Issue : 2  |  Page : 178-179
 

Non-Hodgkin's lymphoma of the infratemporal fossa: A case report


1 Department of Surgical Oncology, Rockland Hospital, New Delhi, India
2 Mahavir Cancer Sansthan, Patna, India
3 Department of Genito-Urinary Oncology, Rajiv Gandhi Cancer Research Institute, Delhi, India

Date of Web Publication5-Feb-2016

Correspondence Address:
A K Giri
Department of Surgical Oncology, Rockland Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.175804

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How to cite this article:
Giri A K, Vishnu Vardhan G V, Bassi K K, Giri S. Non-Hodgkin's lymphoma of the infratemporal fossa: A case report. Indian J Cancer 2015;52:178-9

How to cite this URL:
Giri A K, Vishnu Vardhan G V, Bassi K K, Giri S. Non-Hodgkin's lymphoma of the infratemporal fossa: A case report. Indian J Cancer [serial online] 2015 [cited 2020 Jul 12];52:178-9. Available from: http://www.indianjcancer.com/text.asp?2015/52/2/178/175804


Sir,

Non-Hodgkin's lymphoma (NHL) forms a varied group of hematological malignancies, which differ in natural history, response to therapy and prognosis. Extra-nodal manifestations are common, and head and neck is the second most common site after the gastrointestinal tract.[1] We report a case of primary NHL involving the infratemporal fossa ITF. This is the third case report of primary NHL of the ITF to the best of our knowledge.[2],[3]

A 44-year male presented with a progressively increasing painless bulge over the left cheek for 1 year associated with otalgia. Clinical examination revealed a diffuse tender sub-mucosal swelling involving the left upper gingiva, the mucoperiosteum of the hard palate, and the adjoining buccal mucosa. No regional or generalized lymphadenopathy was seen. Contrast-enhanced computerized tomography (CT) scan revealed a mass lesion involving the left ITF extending up to the left side of the hard palate and check [Figure 1]. Fine-needle aspiration was inconclusive. The tumor was excised by a transmandibular approach. Clearance of the ITF, infrastructure maxillectomy and wide excision of the buccinators space was done. Histopathological examination revealed differentiated proliferation of lymphoid tissue compartmentalized by thin fibrous septae consistent with small lymphocytic lymphoma [Figure 2]. Lymphoid cells were positive for CD45 and CD20 immunostains. He received adjuvant radiation to the face (25#, 50 Gy) postoperatively. Contrast enhanced CT scan done after one year did not reveal any recurrence [Figure 3]. The patient is disease-free after 3 years of follow-up.
Figure 1: Contrast-enhanced CT axial section showing mass in the left infratemporal fossa

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Figure 2: Microphotograph showing differentiated proliferation of lymphoid tissue compartmentalized by a thin fibrous core suggestive of small.cell lymphocytic lymphoma. (×100)

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Figure 3: A contrast-enhanced CT axial section showing a post-resection defect in the left infratemporal fossa, with no evidence of recurrence after 1 year of treatment

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NHLs and Hodgkin's lymphoma are the most commonly occurring hematological malignancies. The head-and-neck region is a common site for extra-nodal manifestation, with Waldeyer's ring being the most frequently involved sub-site.[4] Careful history and physical examination is the basis to determine the extent of the disease and is a key factor in the therapeutic decision-making. Fever, night sweat and weight loss (B symptoms) are known to have an adverse prognosis. Chest radiograph is abnormal in fewer than 50% of patients. CT scan can identify the nodal and extra-nodal sites of involvement, and provides an important approach to monitoring the response to therapy. The value of magnetic resonance imaging (MRI) is limited but may be useful in identifying bone marrow and central nervous system (CNS) involvement. Positron-emission tomography may improve staging at the time of diagnosis and monitoring response to therapy.

The Ann Arbor Staging System is used to classify lymphoma. The WHO\REAL lymphoma classification distinguishes lymphoma entities based on their clinical, pathologic, immunologic, and genetic characteristics. At present the International Prognostic Index (IPI) is most valuable system to stratify patients with lymphoma, which takes into account age, serum lactate dehydrogenase (LDH), performance status (Eastern Cooperative Oncology Group (ECOG), stage and number of extra-nodal sites.

Treatment of NHL consists of chemotherapy, radiotherapy, or surgery. Patients with localized disease are treated primarily by radiotherapy (30-55 Gy). Sometimes, in the case of limited extra-nodal NHL, surgery with or without radiotherapy is used.[5] Patients with stage II-IV are treated primarily with chemotherapy. CHOP chemotherapy is used in most cases using the monoclonal antibody rituximab added to CD20-positive cases. High-dose chemotherapy and autologous bone marrow transplantation can be curative in some patients after relapse from standard therapy.

 
  References Top

1.
Conley JJ. Tumors of infratemporal fossa. Arch Otolaryngol 1964;79:498-504.  Back to cited text no. 1
[PUBMED]    
2.
Benson-Mitchell R, Warwick-Brown N, Chappell ME. Non-Hodgkin's lymphoma presenting as an isolated temporal soft tissue swelling. J Laryngol Otol 1996;110:161-2.  Back to cited text no. 2
    
3.
Thakur JS, Minhas RS, Mohindroo NK, Sharma DR, Mohindroo S, Thakur A. Primary non-Hodgkin's lymphoma of the infratemporal fossa: A rare case report. Head Neck Oncol 2009;1:20.  Back to cited text no. 3
    
4.
Shima N, Kobashi Y, Tsutsui K, Ogawa K, Maetani S, Nakashima Y, et al. Extranodal non-Hodgkin's lymphoma of the head and neck. A clinicopathological study in the Kyoto-Nara area of Japan. Cancer 1990;66:1190-7.  Back to cited text no. 4
    
5.
Kim SJ, Kang HJ, Kim JS, Oh SY, Choi CW, Lee SI, et al. Comparison of treatment strategies for patients with intestinal diffuse large B-cell lymphoma: Surgical resection followed by chemotherapy versus chemotherapy alone. Blood 2011;117:1958-65.  Back to cited text no. 5
    


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