Oropharyngeal large B cell lymphoma

Case contributed by Ian Bickle
Diagnosis certain


Swollen left side of neck for 2-3 weeks. Hoarse voice. Dysphagia. O/E: left neck mass and oropharyngeal mass.

Patient Data

Age: 45 years
Gender: Female

Large enhancing well defined oropharyngeal mass with bulk dimensions of 7.3 x 5.5 cm centered on the left side oropharynx with right-sided extension.  The mass is causing severe narrowing of the oropharynx to less than 1 cm. The lesion extends superiorly to the left nasopharynx, causing asymmetry, and inferiorly to the base of the tongue, which it displaces. The mass abuts the prevertebral space without invasion of the longus capiti.

High T2 signal and enhancement in left masticator space surrounding the pterygoids muscles and mandibular ramus suggestive of disease extension.

Multiple bilateral enlarged cervical lymph nodes, the largest on the left measures 9.7 cm centered on the left submandibular space and compresses both the submandibular and parotid glands. 2.2 cm right level Ib node.

The carotid sheath vessels and left retromandibular vessels are intact.

No lower visualized intracranial extension is seen. Both parotid and thyroid glands are normal.

Case Discussion

Huge symptomatic oropharyngeal mass with airway compromise and advanced nodal involvement.

An fibroscopic biopsy was performed.

Oropharyngeal biopsy:   Diffuse large B cell lymphoma (CD20,CD79a,BCl 6 positive, CD5,CD10,CD56 and cyclin D1 negative)

Another example of an extreme head and neck space pathology.  It continues to amaze me how late many patients present with pathology.

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