Computed tomography features of enlarged tonsils as a first symptom of non-Hodgkin's lymphoma

The tonsils are the most commonly involved primary part of non Hodgkin's lymphoma (NHL) of the head and neck, which usually happens in the Waldeyer's ring. Our study describes the features of computed tomography on enlarged tonsils as a first symptom of NHL and the characteristics of the involved cervical lymph nodes.

A retrospective review was performed on 130 patients with primary extranodal lymphomas of the head and neck over 16 years. Of them 22 untreated patients showed tonsil lesions as a first symptom.

Bilateral enlarged tonsils were involved in 13 patients, and unilateral lesions were in 9 patients. The lesions in 20 patients appeared mass like, while 2 patients had diffuse thickening. There were 8 patients with simultaneous invasion of the nasopharynx, soft palate, and epiglottis. Of the 19 patients that underwent enhanced CT scans, 15 patients demonstrated slight homogeneous enhancement, 4 with crannied or a patch of low density, and 1 with ring like enhancement. All 22 patients appeared to have cervical lymph nodes involvement. The upper groups of cervical lymph nodes were involved bilaterally in 13 patients, unilaterally in 9 patients. The middle groups were involved bilaterally in 7 patients, unilaterally in 10 patients. The lower groups were involved bilaterally in 2 patients, and unilaterally in 5 patients. After contrast administration, lymph nodes showed homogeneous density and slight enhancement in 11 patients, heterogeneous enhancement with necrosis and cystic changes in 6 patients, and ring like enhancement in 2 patients.

Bilateral involvement, homogeneous density, and slight enhancement are characteristics of tonsil involvement of non Hodgkin's lymphoma. Bilateral upper groups of cervical lymph nodes are the most frequently involved lymph nodes, which are often shown with homogeneous density and slight enhancement.