Clinical presentation and treatment outcomes of primary ocular adnexal MALT lymphoma in Thailand

BACKGROUND: Primary ocular adnexal extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (POML) is the most common subtype of lymphoma involving the eyes in Thailand. We sought to assess the characteristics and treatment outcomes of patients with POML in Thailand. METHODS: We retrospectively reviewed patient data and included patients diagnosed with POML between January 2004 and December 2016 at Chiang Mai University Hospital and King Chulalongkorn Memorial Hospital, Thailand. We collected and analyzed patients' clinical characteristics and treatment outcomes. RESULTS: Among 146 patients with lymphoma involving the eyes, 121 (82%) were diagnosed with POML. Sixty-four (52.9%) were women with median age 58 (range, 22–86) years. The most common presenting symptom was orbital mass (71.1%). Common sites of origin were the orbit (46.3%) and lacrimal gland (34.7%). At presentation, 22.3% of patients had bilateral eye involvement. About half of patients had stage I disease (N=59, 56.2%) and 20% had stage IV. Most patients (73.3%) had a low-risk International Prognostic Index. Radiotherapy was the main treatment for patients with limited-stage disease (66.7% in stage I and 56.5% in stage II). The overall response rate was 100% with complete response rates 80%, 77.3%, and 64.7% for stages I, II, and IV, respectively. Five-year progression-free survival (PFS) and overall survival were 66.1% and 94.0%, respectively. For patients with limited-stage disease, radiotherapy significantly improved PFS compared with treatment not involving radiotherapy (5-year PFS 89.9% vs. 37.3%, P=0.01). CONCLUSION: We revealed that POML has good response to treatment, especially radiotherapy, with excellent long-term outcome.

Primary Small B-cell Lymphoma (MALT Lymphoma) at Lingual Tonsil: A Case Report.

Aims: Primary non-Hodgkin’s lymphomas of the oropharyngeal region are rare. We report a case of a small B-cell lymphoma (MALT lymphoma) involving base of tongue. The patient was successfully treated with wide excision of the lesion followed by radiotherapy. Presentation of Case: A 75-year-old female Caucasian patient was referred to our clinic with complaints of foreign body sensation in the throat and progressively worsening snoring over 4 months. Oropharyngeal examination revealed a 3x3-cm smooth mass originating from the left side of the base of tongue and moving with protrusion of the tongue. Excisional biopsy revealed a low-grade small B-cell lymphoma with lambda monoclonal plasmacytic differentiation [extranodal marginal zone lymphoma of mucosaassociated lymphoid tissue (MALT) with lambda monoclonal plasmacytic differentiation]. The neoplastic population was consisted of small lymphoid B-cells and lambdamonoclonal plasma cells. Lymphoid cells showed CD20(+), CD5(-), CD23(-), CD10(-), BCL-6(-), IgD(-), BCL-2(+). In the neoplasm were seen few mitoses, and cellular proliferation marker Ki-67 was approximately 15%. Magnetic resonance imaging of the head and neck showed a well-circumscribed solid mass originating from the base of left side tongue. Bone marrow aspiration biopsy showed no evidence of disease. Computerized tomographic scans of the thorax and magnetic resonance imaging of the abdomen showed no adenopathy. Tumor was determined to be at Stage I. Discussion and Conclusion: Primary non-Hodgkin’s lymphomas involving oropharyngeal region should be considered in differential diagnosis of all lesions located in this region. To our knowledge, a case of small B-cell lymphoma of the base of the tongue is rarely reported. An appropriate evaluation of the clinical presentation along with histopathologic and immunohistochemical evaluation of biopsy specimen may aid in the diagnosis and effective treatment.

Extranodal Marginal Zone Lymphoma Occurring along the Trachea and Central Airway

Extranodal marginal zone lymphoma is a low-grade B cell lymphoma that presents with an indolent clinicopathologic nature. Although this tumor can occur in various sites, including the gastrointestinal tract and lungs, it develops and spreads extremely rarely along the trachea and central airway. We report a case of extranodal lymphoma of mucosa-associated lymphoid tissue with tracheobronchial involvement. An 83-year-old woman presented with a cough and dyspnea. Bronchoscopic evaluation confirmed diffuse, multiple nodular lesions in both the trachea and large bronchi, and she was diagnosed with an extranodal marginal zone lymphoma of the tracheobronchial tree. After systemic chemotherapy, she survived for more than 18 months.