Lymphomas involving Waldeyer's ring: placement, paradigms, peculiarities, pitfalls, patterns and postulates

This review revisits Waldeyer's ring lymphomas as classified by the World Health Organisation.

Sources of data include international studies on Waldeyer's ring lymphomas as well as from personal observations gleaned from lymphoma statistics of Singapore General Hospital, Changi General Hospital, Tan Tock Seng Hospital and National University Hospital within the last decade or so.

Waldeyer's ring shares many of the histopathological trends of the rest of mucosa-associated lymphoid tissue (MALT), such as the high frequency of diffuse large B-cell lymphomas, and the relative rarity of follicular lymphomas in spite of its rich endowment with reactive lymphoid follicles. However, extranodal marginal zone lymphoma or "MALToma" may not be as frequently encountered as in other mucosal sites. Furthermore, the placement of Waldeyer's ring is unique in that stark comparisons with the lymphopathology of the immediately anterior oronasal cavities can be made, with intriguing peculiarities such as the abrupt reversal of the ratio of B-cell to T/NK-cell lymphoma frequency upon crossing the imaginary line that separates the 2 regions. The differential diagnosis with regionally common lymphoma mimics, in particular reactive parafollicular hyperplasia and nasopharyngeal undifferentiated (lymphoepithelial) carcinoma of Schmincke pattern, both often aetiologically related to Epstein-Barr viral infection, is also discussed.

Recognition of the peculiarities and patterns of Waldeyer's ring lymphomas is important for accurate pathologic assessment. Postulates that attempt to account for the patterns and peculiarities of Waldeyer's ring lymphopathology can be used to direct further research.