Primary mantle cell lymphoma of the tonsil: An uncommon case

Non-Hodgkin lymphoma of the Waldeyer’s ring is a relatively rare entity and the palatine tonsil is the most frequently involved site. Although the exact aetiology remains unclear, a number of predisposing factors have been identified including human immunodeficiency virus and Epstein-Barr infection. An 82-year-old male patient presented with a sensation of fullness of the throat. Physical examination revealed a smooth non-tender mass in the right palatine tonsil measuring approximately 3.5 x 3cm. Serology was negative for human immunodeficiency virus and Epstein- Barr virus. Computer tomography revealed a non-enhancing right tonsillar mass but without any signs of neck lymphadenopathy. The patient underwent bilateral tonsillectomy. Histological examination confirmed a diagnosis of mantle cell lymphoma of B phenotype. Immunohistochemically, the neoplastic cells were positive for CD19, CD20, CD79a, CD22, Bcl 2, CD5, Cyclin D1 and negative for CD10, CD57, EBV, CD3, CKAE1, CKAE3. Bone marrow biopsy did not reveal lymphomatous involvement. The patient received chemotherapy based on CHOP protocol combined with Rituximab. At 18-month follow-up after diagnosis, he remains disease-free. Non-Hodgkin lymphomas rarely involve the tonsils and the vast majority of them are of B-cell origin. A combined treatment consisting of chemotherapy and radiotherapy leads to a satisfactory outcome in patients with this uncommon neoplasm. The current results supported its good prognosis at early stage.