|LETTER TO THE EDITOR
|Year : 2015 | Volume
| Issue : 2 | Page : 178-179
Non-Hodgkin's lymphoma of the infratemporal fossa: A case report
AK Giri1, GV Vishnu Vardhan2, KK Bassi1, S Giri3
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 Publication||5-Feb-2016|
A K Giri
Department of Surgical Oncology, Rockland Hospital, New Delhi
Source of Support: None, Conflict of Interest: None
|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
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. 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.,
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. 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. 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.
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[Figure 1], [Figure 2], [Figure 3]