Review of Patients with Lymphoma of the Head and Neck
Lymphomas comprise of a heterogeneous group of malignancies that can arise in different nodal and extranodal sites in the head and neck and are generally divided into Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL)1. Lymphoma is the fifth most common malignancy in the US and the second most common malignancy in the head and neck. More importantly, the incidence of NHL has risen over the last several decades1. The most common presentation of lymphomas in the head and neck is enlarging or persistent painless cervical lymphadenopathy with/without constitutional symptoms. Other extra-nodal locations of lymphoma in the head and neck include Waldeyer’s ring, oral cavity, nasal cavity, salivary glands, thyroid, maxilla and mandible2. Early diagnosis of lymphomas of the head and neck and proper referral to Medical Oncology and Hematology is essential in prolonging survival in these patients since chemotherapy is the mainstay of treatments for lymphomas of the head and neck.
Materials/Methods:
Retrospective chart review was performed for patients from Bellevue Hospital and NYU Langone Medical Center from January 2006 till January 2013. Patient diagnosis, type, location and stage of lymphoma, time elapsed till treatment, and course of treatment was recorded for each patient. A total of 28 patients were diagnosed with lymphoma of the head and neck with FNA and/or biopsy. CT with contrast and/or MRI were performed and referral to Hem/Medical oncology was made for all patients.
Results:
The age of the patients ranged from 20 year old to 90 year old with an average of 48.1 years old at diagnosis. Sixty-seven percent of patients were male. Ninety-six percent of patients presented with Stage I-III Non-Hodgkin Lymphoma of varying forms including Burkitt’s, Diffuse Large Cell B cell, small cell B cell, marginal zone B-cell, follicular B-cell, mature T-cell lymphoma, NK T-cell. Of the patients diagnosed with NHL, fifty-nine percent presented with lymphoma of B-cell origin. Eighty-nine percent of patients present initially with extra-nodal involvement. Proper referral to Hem/Medical oncology was made and all patients started chemotherapy and/or radiation therapy within two weeks.
Conclusion:
Oral and Maxillofacial Surgeons must perform a thorough examination of the head and neck including the oral cavity, oropharynx, Waldeyer’s ring, nasopharynx for any patients who present with a new lesion of the head and neck and any constitutional symptoms. Early diagnosis and treatment of lymphomas of the head and neck can play a crucial role in preventing bone marrow or CSF infiltration and prolong survival by early treatment with chemotherapy.
References:
1. Deschler et al. Lymphomas. Otolaryngol Clin N Am 36 (2003) 625-646.
2. Ferry et al. Hodgkin and non-Hodgkin lymphoma of the head and neck: clinical, pathologic, and imaging evaluation. Neuroimag Clin N Am 13 (2003) 371-392.