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Osto M, Rehman R, Ko A. A Rare Presentation of Acute Respiratory Distress Due to Diffuse Large B-Cell Lymphoma of the Tongue Base. Cureus 2021; 13:e15124. [PMID: 34159026 PMCID: PMC8213379 DOI: 10.7759/cureus.15124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Primary diffuse large B-cell lymphoma of the tongue base (BOT) is an extremely rare entity with only a few cases described in the English literature to date. The incidence of BOT non-Hodgkin’s lymphoma (NHL) increases with age, most commonly after the sixth decade of life with no observed gender differences. Our patient presented with a six-month history of right neck swelling, one-month history of dysphagia, a change in voice, and ultimately acute airway distress, which led to a tracheostomy. We report an extremely rare case of a diffuse large B-cell lymphoma presenting with airway distress. The patient was treated using rituximab-cyclophosphamide-doxorubicin-vincristine-prednisone (R-CHOP) chemotherapy, a five-day steroid course, and one intrathecal methotrexate. The patient recovered completely and is alive at the time of this writing. NHLs occur more commonly in patients like ours with a prior history of congenital immunodeficiency and celiac disease, exposure to radiation, acquired immune deficiency syndrome, rheumatoid arthritis, or Sjögren’s syndrome. Most reported cases of BOT NHLs may cause dysphagia, pharyngeal foreign body sensation, or progressive dyspnea. This case highlights that although NHL of the tongue is a very rare entity, it should not be overlooked and should always be in the differential diagnosis among various benign and malignant tumors and may cause rapid respiratory deterioration.
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Affiliation(s)
- Muhammad Osto
- Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, USA
| | - Rafey Rehman
- Department of Radiation Oncology, Beaumont Hospital, Royal Oak, USA
| | - Alvin Ko
- Otolaryngology - Head and Neck Surgery, Henry Ford Health System, Detroit, USA
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Zahedi M, Hizomi Arani R, Tohidi M, Haghighi S, Mehrpour M, Hadaegh F. Nasopharyngeal B-cell lymphoma with pan-hypopituitarism and oculomotor nerve palsy: a case report and review of the literature. BMC Endocr Disord 2020; 20:163. [PMID: 33143716 PMCID: PMC7607655 DOI: 10.1186/s12902-020-00644-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/23/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Primary nasopharyngeal lymphoma (NPL) is a very rare tumor of Waldeyer ring (WR) lymphoid tissue. It is challenging to differentiate lymphoma infiltration of pituitary from a pituitary adenoma, meningioma infiltration, and other sellar lesions to plan a suitable treatment strategy. We presented for the first time a unique case of NPL with an unusual presentation of oculomotor nerve palsy associated with pan-pituitary involvement in a diabetic patient. CASE PRESENTATION A 64-year old diabetic woman with no previous history of malignancy presented with intermittent diplopia for about the last nine months. Severe headache, left eye ptosis and hypoglycemic episodes were added to her symptoms after a while. Further complaints include generalized weakness, loss of appetite, generalized musculoskeletal pain, and 6-7 kg weight loss within six months. Her family history was unremarkable. Physical examinations of eyes indicated left eye 3rd, 4th, and 6th nerve palsy. But, she was not anisocoric, and the pupillary reflexes were normal on both eyes. No lymphadenopathy, organomegaly and other abnormalities were found. Magnetic resonance imaging (MRI) showed a heterogeneous enhancement in the seller and suprasellar regions, enlargement of the stalk, parasellar dural enhancement and thickening of the sphenoid sinus without bone erosion. Also, both cavernous sinuses were infiltrated and both internal carotid arteries were encased by the neoplastic lesion. It suggested an infiltrative neoplastic lesion which compressed the cranial nerves. Pituitary hormone levels assessment indicated a pan-hypopituitarism. Following nasopharyngeal mucosal biopsy, the immunohistochemistry (IHC) findings revealed a low-grade non-Hodgkin's B-cell lymphoma. Systemic workup, including cerebrospinal fluid (CSF) studies, bone marrow aspiration, chest and abdominopelvic high-resolution computed tomography (HRCT) indicated no other involvement by the lymphoma. After chemotherapy courses, central adrenal insufficiency, partial central diabetes incipidious (CDI) and central hypothyroidism have been resolved. To our best knowledge, we found 17 cases of NPL with cranial nerve palsy, 1 case of NPL with pan-hypopituitarism and no NPL case with both cranial nerve palsy and pituitary dysfunction. CONCLUSIONS The incidence of cranial neuropathy in patients with diabetes should not merely be attributed to diabetic neuropathy without further evaluation.
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Affiliation(s)
- Maryam Zahedi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Parvaneh Street, P.O. Box: 19395-4763, Tehran, Velenjak, Iran
| | - Reyhane Hizomi Arani
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Parvaneh Street, P.O. Box: 19395-4763, Tehran, Velenjak, Iran
| | - Maryam Tohidi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Parvaneh Street, P.O. Box: 19395-4763, Tehran, Velenjak, Iran
| | - Shirin Haghighi
- Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Mehrpour
- Stroke center, Firoozgar General Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Parvaneh Street, P.O. Box: 19395-4763, Tehran, Velenjak, Iran.
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M K, V S, M A MS. Application of Different methods for Reducing Radiation Dose to Breast during MDCT. J Biomed Phys Eng 2018; 8:341-346. [PMID: 30568923 PMCID: PMC6280114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 08/07/2018] [Indexed: 06/09/2023]
Abstract
The increased use of computed tomography (CT) and its high radiation dose have led to great concerns about its potential for radiation induced cancer risks. Breast is a radiosensitive tissue based on tissue weighting factors assigned by the International Commission on Radiological Protection (ICRP). Moreover, the dose is maximal on the surface of the patient. Therefore, strategies should be taken to reduce radiation dose to the breast. The aim of this review is to introduce methods used for reducing radiation dose to breast in thoracic CT and review related performed studies. The literature indicates that bismuth shielding increases image noise and CT numbers as well as introducing streak artifacts. Tube current modulation (TCM) technique and iterative reconstruction algorithms can provide some levels of dose reduction to radiosensitive organs and superior image quality without the disadvantages of bismuth shielding. However, they are not available on all CT scanners, especially in low-income countries. Such centers may have to continue using bismuth shields to reduce the dose until these superior techniques become available at lower costs in all CT scanners. Furthermore, design and manufacture of new shields with the lower impact on image quality are desirable.
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Affiliation(s)
- Keshtkar M
- Radiology Department, Faculty of Paramedicine, Aja University of Medical Sciences, Tehran, Iran
| | - Saba V
- Radiology Department, Faculty of Paramedicine, Aja University of Medical Sciences, Tehran, Iran
| | - Mosleh-Shirazi M A
- Ionizing and Non-Ionizing Radiation Protection Research Center and Department of Radio-Oncology, Shiraz University of Medical Sciences, Shiraz
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Li C, Ma X, Pan Z, Lv F, Xia Z, Xue K, Zhang Q, Ji D, Cao J, Hong X, Guo Y. Role of radiotherapy in patients with limited diffuse large B-cell lymphoma of Waldeyer's ring in remission after R-CHOP immunochemotherapy. Leuk Res 2018; 74:80-85. [PMID: 30316031 DOI: 10.1016/j.leukres.2018.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/18/2018] [Accepted: 09/22/2018] [Indexed: 11/27/2022]
Abstract
The standard treatment of waldeyer's ring DLBCL remains controversial. This retrospective study was designed to evaluate the role of consolidation radiotherapy (RT) in patients with stage I/II diffuse large B-cell lymphoma (DLBCL) limited in Waldeyer's ring (WR). We included 72 patients, 42 were treated with immunochemotherapy alone (CT group) and 30 were treated with immunochemotherapy followed by radiotherapy (CT + RT group). All patients received at least 3 cycles of R-CHOP regimen and achieved complete remission (CR) after immunochemotherapy. After 53 months median follow-up time, the 5-year progression-free survival (PFS) rates in CT + RT group vs. CT group were 93.3% vs. 92.5% (P = 0.896), the 5-year overall survival (OS) rates were 96.7% vs. 94.4% (P = 0.649). Patients with oropharyngeal primary had relatively better 5-year PFS and OS rates compared to nasopharyngeal primary (PFS: 98.2% vs. 73.3%, p = 0.001; OS: 100% vs. 79.0%, p < 0.001). Moreover, the primary site was the only independent prognostic factor for PFS in the multivariate analysis (p = 0.012, HR 16.858 [95% CI: 1.883-150.933]).
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Affiliation(s)
- Chunyan Li
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China; Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
| | - Xuejun Ma
- Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China; Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China.
| | - Ziqiang Pan
- Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China; Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China.
| | - Fangfang Lv
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China; Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
| | - Zuguang Xia
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China; Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
| | - Kai Xue
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China; Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
| | - Qunling Zhang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China; Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
| | - Dongmei Ji
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China; Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
| | - Junning Cao
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China; Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
| | - Xiaonan Hong
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China; Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
| | - Ye Guo
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China; Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China; Department of Oncology, Tongji University East Hospital, Shanghai, People's Republic of China.
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Kato H, Kanematsu M, Kawaguchi S, Watanabe H, Mizuta K, Aoki M. Evaluation of imaging findings differentiating extranodal non-Hodgkin's lymphoma from squamous cell carcinoma in naso- and oropharynx. Clin Imaging 2013; 37:657-63. [DOI: 10.1016/j.clinimag.2012.11.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Revised: 10/21/2012] [Accepted: 11/20/2012] [Indexed: 02/07/2023]
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Xie CM, Liu XW, Mo YX, Li H, Geng ZJ, Zheng L, Lv YC, Ban XH, Zhang R. Primary nasopharyngeal non-Hodgkin’s lymphoma: imaging patterns on MR imaging. Clin Imaging 2013; 37:458-64. [DOI: 10.1016/j.clinimag.2012.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 06/20/2012] [Accepted: 07/25/2012] [Indexed: 11/24/2022]
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Liu XW, Xie CM, Mo YX, Zhang R, Li H, Huang ZL, Geng ZJ, Zheng L, Lv YC, Wu PH. Magnetic resonance imaging features of nasopharyngeal carcinoma and nasopharyngeal non-Hodgkin's lymphoma: are there differences? Eur J Radiol 2011; 81:1146-54. [PMID: 21864999 DOI: 10.1016/j.ejrad.2011.03.066] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 03/12/2011] [Accepted: 03/16/2011] [Indexed: 12/19/2022]
Abstract
PURPOSE To describe differences in the primary tumour and distribution of cervical lymphadenopathy for cases of nasopharyngeal carcinoma (NPC) and nasopharyngeal non-Hodgkin's lymphoma (NPNHL) using magnetic resonance (MR) imaging. MATERIALS AND METHODS MR images of patients with NPC (n = 272) and NPNHL (n = 118) were independently reviewed by two experienced radiologists. RESULTS NPC had a higher incidence of tumour invasion associated with the levator and tensor muscles of the velum palatine, the longus colli and medial pterygoid muscles, the base of the pterygoid process, the clivus, the base and greater wing of the sphenoid bone, the petrous apex, the foramen lacerum, the foramen ovale, the hypoglossal canal, and intracranial infiltration. In contrast, NPNHL had a higher incidence of tumour invasion associated with the hypopharynx, the palatine and lingual tonsils, as well as the ethmoid and maxillary sinuses. NPNHL also had a higher incidence of extensive and irregular bilateral lymphadenopathy, and lymphadenopathy in the parotid. CONCLUSIONS NPC more often involved an unsymmetrical tumour with a propensity to invade both widely and deeply into muscle tissue, the fat space, the neural foramen, and the skull base bone. In contrast, NPNHL tended to be a symmetrical and diffuse tumour with a propensity to spread laterally through the fat space and along the mucosa to the tonsils of the oropharynx and hypopharynx. These differences facilitate a differentiation of these diseases using MR images, and enhance our understanding of the biological behavior of these malignant tumours of the nasopharynx.
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Affiliation(s)
- Xue-wen Liu
- State Key Laboratory of Oncology in Southern China and Medical Imaging and Minimally Invasive Interventional Center, Cancer Center, Sun Yat-sen University, Guangzhou, China
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B lymphoblastic lymphoma presenting as a tumor of the nasopharynx in an adult patient. Head Neck Pathol 2010; 4:318-23. [PMID: 20730608 PMCID: PMC2996508 DOI: 10.1007/s12105-010-0206-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 08/10/2010] [Indexed: 10/19/2022]
Abstract
In adults, non-Hodgkin's lymphoma (NHL) is the second most common neoplasm found in the head and neck region after squamous cell carcinoma. Within this region, primary NHL of the nasopharynx is rare. We report the case of a 28-year-old male diagnosed with a B lymphoblastic lymphoma (CD20-; CD79a+; CD3-; CD10+; PAX5+, CyclinD1-; TdT+) of the nasopharynx extending to the deep and superficial structures of the right hemiface, to the skull base with an intracranial component and a small but detectable bone marrow involvement, who was started on chemotherapy with a complete response. To the best of our knowledge, this is the first case of a primary nasopharynx B-LBL in an adult patient with such aggressive regional spread to be reported in the literature.
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