Key Points
• In the current case study, a 62-year-old man with a previous history of celiac disease and IgA deficiency presented with airway distress and a 6-month history of right neck swelling, as well as 1 month of dysphonia, dyspnea while supine, and dysphagia. He was subsequently diagnosed with primary diffuse large B-cell lymphoma (DLBCL) of the tongue base (BOT) and successfully treated with R-CHOP, steroids, and intrathecal methotrexate.
• “Airway concerns in the BOT subsite must be carefully considered primarily during initial presentations and secondarily as many treatment regimens may cause delayed airway distress from tumor edema and/or mucositis,” the authors wrote. “Most of the head and neck NHLs are of B-cell origin, most commonly the diffuse large B-cell type. Due to its low incidence, no consensus or treatment guidelines exist for BOT lymphoma. Many NHLs show good sensitivity to typical chemotherapy regimens such as the R-CHOP regimen used in our patient. Some have recommended treating well-localized lesions below stage II with radiotherapy alone or with excisional biopsy followed by radiotherapy.”
• The authors concluded that although NHL at the level of the tongue base is rare, it should be placed on the list of differential diagnoses. Diagnosis requires biopsy and immunohistochemical analysis because “treatment and prognosis of malignant lymphomas are vastly different than other pathologies of this region.”