Öz
Amaç: Tonsil lenfomaları, özellikle ekstranodal bölgelerdeki non-Hodgkin lenfomalar, baş ve boyun malignitelerinin önemli bir alt kümesidir. Bu lenfomaların klinik ve radyolojik özelliklerini anlamak, özellikle bu malignitelerin belirgin insidansı ve ayırt edici patofizyolojisi göz önüne alındığında, mevcut bilgiyi artırmak ve tedavi yaklaşımlarını rafine etmek için merkezi öneme sahiptir.
Gereç ve Yöntemler: İki üniversite hastanesinde tonsiller lenfoma tanısı alan 45 hasta kapsayan retrospektif bir çalışma gerçekleştirildi. Demografi, semptomlar, klinik ve patolojik bulgular ve tedavi detaylarını içeren kapsamlı veriler analiz edildi. Çeşitli istatistiksel testler, tedavi yanıtlarını ve prognozu etkileyen faktörleri inceledi.
Bulgular: Hastalar genellikle disfoni, disfaji ve dispne ile başvurdu. Hipertansiyon ve diyabet mellitus en sık saptanan iki komorbidite idi. Tanı, büyük ölçüde eksizyonel biyopsiye dayanıyordu ve en yaygın alt tip diffüz büyük B-hücreli lenfoma olarak saptandı. İlk basamak tedavide, sıklıkla R-CHOP ile başlanmış ve iyi bir objektif yanıt oranına ulaşılmıştı. Ortalama progresyona kadar geçen süre 13 ay, medyan progresyonsuz sağkalım 10 ay ve medyan genel sağkalım 55.8 ay olarak hesaplandı. Yaş, Ann Arbor evresi, lenfoma alt tipi, R-IPI skorları, double ekspresyon durumu ve birinci basamak tedaviye objektif yanıt varlığı gibi değişkenlerin, PFS ve OS'ye anlamlı etkisi olmakla beraber çok değişkenli analizde bağımsız bir faktör bulunamadı.
Sonuç: Bulgular, tonsiller lenfomaları anlamada kapsamlı, çok yönlü analizlerin önemini vurgulamaktadır. Her ne kadar sağkalım analizleri için bağımsız bir risk faktörü olmasa da, yaş, Ann Arbor evresi, lenfoma alt tipi, R-IPI skorları, double ekspresyon durumu ve birinci basamak tedaviye objektif yanıt varlığı gibi değişkenler, PFS ve OS üzerinde etkili olup, gelecekteki araştırmalar ve potansiyel tedavi yaklaşımlarının kişiye özel olarak düzenlenmesi için değerli veri sunmaktadır.
Anahtar Kelimeler
Kaynakça
- Lee Y, Van Tassel P, Nauert C, North L, Jing B. Lymphomas of the head and neck: CT findings at initial presentation. Am J Roentgenol 1987;149:575–81.
- Yuen A, Jacobs C. Lymphomas of the head and neck. Semin Oncol 1999;26:338–45.
- Kaygusuz G, Cansız C, Kuzu I, Dizbay Sak S. Tonsil maligniteleri arasında lenfoproliferatif hastalıkların dağılımı. Türk Patoloji Dergisi 2008;24:166-7.
- Cobleigh MA, Kennedy JL. NonHodgkin’s Lymphomas of the Upper Aerodigestive Tract and Salivary Glands. Otolaryngologic Clinics of North America. 1986;19(4):685-710.
- Saul SH, Kapadia SB. Primary lymphoma of Waldeyer's ring. Clinicopathologic study of 68 cases. Cancer. 1985;56(1):157-66.
- Rosenberg SA, Diamond HD, Jaslowitz B, Craver LF. Lymphosarcoma: a review of 1269 cases. Medicine (Baltimore). 1961;40:31-84.
- Epstein JB, Epstein JD, Le ND, Gorsky M. Characteristics of oral and paraoral malignant lymphoma: a population-based review of 361 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;92(5):519 25.
- Rayess HM, Nissan M, Gupta A, Carron MA, Raza SN, Fribley AM. Oropharyngeal lymphoma: A US population based analysis. Oral Oncol. 2017;73:147-51.
- Yan S, Ma J, Yang M, Liu B, Li S, Yang L, et al. Analysis of the Clinicopathologic Characteristics and Prognosis of Head and Neck Lymphoma. Anal Cell Pathol (Amst). 2022;2022:4936099.
- Solomides CC, Miller AS, Christman RA, Talwar J, Simpkins H. Lymphomas of the oral cavity: histology, immunologic type, and incidence of Epstein-Barr virus infection. Hum Pathol. 2002;33(2):153-7.
- Lee SJ, Suh CW, Lee SI, Kim WS, Lee WS, Kim HJ, et al. Clinical characteristics, pathological distribution, and prognostic factors in non-Hodgkin lymphoma of Waldeyer's ring: nationwide Korean study. Korean J Intern Med. 2014;29(3):352-60.
- Qin Y, Lu L, Lu Y, Yang K. Hodgkin lymphoma involving the tonsil misdiagnosed as tonsillar carcinoma: A case report and review of the literature. Medicine (Baltimore). 2018;97(7):e9761.
- Quiñones-Avila MdP, Gonzalez-Longoria AA, Admirand JH, Medeiros LJ. Hodgkin Lymphoma Involving Waldeyer Ring. American Journal of Clinical Pathology. 2005;123(5):651-6.
- Çelebi Erdivanlı Ö, Özergin Coşkun Z, Bedir R, Özgür A, Özdemir D, Terzi S, et al. Lymphoma of the Tonsil: A Case Report. Acta Oncologica Turcica. 2014;47(3):63-6.
- Cetinkaya E, Celik M, Ensari N, Suren D, Ocal N. Non-Hodgkin Lenfoma: Bilateral Tonsil Tutulumu. ENTcase. 2019;5(3):172-7.
- Topdag DO, Ozturk M, Topdag M, Buday MC, Ila K. Non-Hodgkin lymphoma presenting with bilateral tonsillar hypertrophy: A case report. Turk Otolarengoloji Arsivi/Turkish Archives of Otolaryngology. 2013;49(4):78-80.
- Kolokotronis A, Konstantinou N, Christakis I, Papadimitriou P, Matiakis A, Zaraboukas T, et al. Localized B-cell non-Hodgkin's lymphoma of oral cavity and maxillofacial region: a clinical study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;99(3):303-10.
- Salplahta D, Comănescu MV, Anghelina F, Ioniţă E, Mogoantă CA, Anghelina L. Non-Hodgkin lymphomas of Waldeyer's ring. Rom J Morphol Embryol. 2012;53(4):1057-60.
- Makepeace AR, Fermont DC, Bennett MH. Non-Hodgkin's lymphoma of the tonsil. Experience of treatment over a 27-year period. J Laryngol Otol. 1987;101(11):1151-8.
- Ezzat AA, Ibrahim EM, El Weshi AN, Khafaga YM, AlJurf M, Martin JM, et al. Localized non-Hodgkin's lymphoma of Waldeyer's ring: clinical features, management, and prognosis of 130 adult patients. Head Neck. 2001;23(7):547-58.
- Mohammadianpanah M, Omidvai S, Mosalei A, Ahmadloo N. Treatment results of tonsillar lymphoma: a 10 year experience. Ann Hematol. 2005;84(4):223-6.
- Abdelwahed Hussein MR. Non-Hodgkin's lymphoma of the oral cavity and maxillofacial region: a pathologist viewpoint. Expert Rev Hematol. 2018;11(9):737-48.
Öz
Aim: Tonsillar lymphomas, specifically non-Hodgkin lymphomas in extranodal regions, are a significant subset of malignancies in the head and neck. Understanding the clinical and radiological characteristics of these lymphomas is pivotal for augmenting current knowledge and refining treatment approaches, particularly considering the notable incidence and distinctive pathophysiology of these malignancies.
Materials and Methods: A retrospective study encompassing 45 patients diagnosed with tonsillar lymphoma across two university hospitals was undertaken. Comprehensive data, including demographics, symptoms, clinical and pathological findings, and treatment details, were analyzed. Various statistical tests explored factors influencing treatment responses and prognosis.
Results: Patients predominantly presented with dysphonia, dysphagia, and dyspnea, alongside a notable prevalence of comorbidities such as hypertension and diabetes mellitus. Diagnosis largely leaned on excisional biopsy, revealing diffuse large B-cell lymphoma as the most common subtype. Treatment was majorly initiated with R-CHOP, witnessing an encouraging initial response. A mean time to progression was 13 months, with a median progression-free survival of 10 months and median overall survival of 55.8 months. Variables such as age, Ann Arbor stage, lymphoma subtype, R-IPI scores, double expression status, and presence of objective response to first line treatment status evidently influenced progression-free survival and overall survival, albeit none was an independent factor in multivariate analysis.
Conclusion: The findings underscore the importance of comprehensive multi-faceted analyses in understanding tonsillar lymphomas. Although there was no independent risk factor for survival analyses, variables such as age, Ann Arbor stage, lymphoma subtype, R-IPI scores, double expression status, and presence of objective response to first line treatment were instrumental in influencing progression-free survival and overall survival, offering valuable insights for future research and potential tailoring of treatment approaches.
Anahtar Kelimeler
Kaynakça
- Lee Y, Van Tassel P, Nauert C, North L, Jing B. Lymphomas of the head and neck: CT findings at initial presentation. Am J Roentgenol 1987;149:575–81.
- Yuen A, Jacobs C. Lymphomas of the head and neck. Semin Oncol 1999;26:338–45.
- Kaygusuz G, Cansız C, Kuzu I, Dizbay Sak S. Tonsil maligniteleri arasında lenfoproliferatif hastalıkların dağılımı. Türk Patoloji Dergisi 2008;24:166-7.
- Cobleigh MA, Kennedy JL. NonHodgkin’s Lymphomas of the Upper Aerodigestive Tract and Salivary Glands. Otolaryngologic Clinics of North America. 1986;19(4):685-710.
- Saul SH, Kapadia SB. Primary lymphoma of Waldeyer's ring. Clinicopathologic study of 68 cases. Cancer. 1985;56(1):157-66.
- Rosenberg SA, Diamond HD, Jaslowitz B, Craver LF. Lymphosarcoma: a review of 1269 cases. Medicine (Baltimore). 1961;40:31-84.
- Epstein JB, Epstein JD, Le ND, Gorsky M. Characteristics of oral and paraoral malignant lymphoma: a population-based review of 361 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;92(5):519 25.
- Rayess HM, Nissan M, Gupta A, Carron MA, Raza SN, Fribley AM. Oropharyngeal lymphoma: A US population based analysis. Oral Oncol. 2017;73:147-51.
- Yan S, Ma J, Yang M, Liu B, Li S, Yang L, et al. Analysis of the Clinicopathologic Characteristics and Prognosis of Head and Neck Lymphoma. Anal Cell Pathol (Amst). 2022;2022:4936099.
- Solomides CC, Miller AS, Christman RA, Talwar J, Simpkins H. Lymphomas of the oral cavity: histology, immunologic type, and incidence of Epstein-Barr virus infection. Hum Pathol. 2002;33(2):153-7.
- Lee SJ, Suh CW, Lee SI, Kim WS, Lee WS, Kim HJ, et al. Clinical characteristics, pathological distribution, and prognostic factors in non-Hodgkin lymphoma of Waldeyer's ring: nationwide Korean study. Korean J Intern Med. 2014;29(3):352-60.
- Qin Y, Lu L, Lu Y, Yang K. Hodgkin lymphoma involving the tonsil misdiagnosed as tonsillar carcinoma: A case report and review of the literature. Medicine (Baltimore). 2018;97(7):e9761.
- Quiñones-Avila MdP, Gonzalez-Longoria AA, Admirand JH, Medeiros LJ. Hodgkin Lymphoma Involving Waldeyer Ring. American Journal of Clinical Pathology. 2005;123(5):651-6.
- Çelebi Erdivanlı Ö, Özergin Coşkun Z, Bedir R, Özgür A, Özdemir D, Terzi S, et al. Lymphoma of the Tonsil: A Case Report. Acta Oncologica Turcica. 2014;47(3):63-6.
- Cetinkaya E, Celik M, Ensari N, Suren D, Ocal N. Non-Hodgkin Lenfoma: Bilateral Tonsil Tutulumu. ENTcase. 2019;5(3):172-7.
- Topdag DO, Ozturk M, Topdag M, Buday MC, Ila K. Non-Hodgkin lymphoma presenting with bilateral tonsillar hypertrophy: A case report. Turk Otolarengoloji Arsivi/Turkish Archives of Otolaryngology. 2013;49(4):78-80.
- Kolokotronis A, Konstantinou N, Christakis I, Papadimitriou P, Matiakis A, Zaraboukas T, et al. Localized B-cell non-Hodgkin's lymphoma of oral cavity and maxillofacial region: a clinical study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;99(3):303-10.
- Salplahta D, Comănescu MV, Anghelina F, Ioniţă E, Mogoantă CA, Anghelina L. Non-Hodgkin lymphomas of Waldeyer's ring. Rom J Morphol Embryol. 2012;53(4):1057-60.
- Makepeace AR, Fermont DC, Bennett MH. Non-Hodgkin's lymphoma of the tonsil. Experience of treatment over a 27-year period. J Laryngol Otol. 1987;101(11):1151-8.
- Ezzat AA, Ibrahim EM, El Weshi AN, Khafaga YM, AlJurf M, Martin JM, et al. Localized non-Hodgkin's lymphoma of Waldeyer's ring: clinical features, management, and prognosis of 130 adult patients. Head Neck. 2001;23(7):547-58.
- Mohammadianpanah M, Omidvai S, Mosalei A, Ahmadloo N. Treatment results of tonsillar lymphoma: a 10 year experience. Ann Hematol. 2005;84(4):223-6.
- Abdelwahed Hussein MR. Non-Hodgkin's lymphoma of the oral cavity and maxillofacial region: a pathologist viewpoint. Expert Rev Hematol. 2018;11(9):737-48.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Hematoloji |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 19 Mart 2024 |
| Gönderilme Tarihi | 14 Ekim 2023 |
| Kabul Tarihi | 27 Aralık 2023 |
| Yayımlandığı Sayı | Yıl 2024 |