Malignant lymphoma of Waldeyer's ring following gastrointestinal lymphoma

Gastrointestinal involvement occurs in a greater proportion of patients with malignant lymphoma of Waldeyer's ring than would be accounted for by change alone. In the absence of direct lymphatic connection between these two sites, the association of these tumors has prompted several hypotheses: that the gastrointestinal lymphoma is a concomitant primary tumor; or that it is related to the swallowing and implantation of tumor cells; or that it represents the homing tendency of the gut-associated lymphoid tissue. Five cases are described in which malignant lymphoma of Waldeyer's ring developed ten months to five and half years after an initial diagnosis of gastrointestinal lymphoma was made. All five patients were female, and the original tumors were of the nodular lymphoma, histiocytic type in 4, and Lennert's lymphoma in 1. The tumors of Waldeyer's ring had similar cytologic features. In 1 patient with small intestinal lymphoma and recurrent tonsillar tumor five and half years later, immunoperoxidase staining of the original and recurrent tumors was positive with anti-IgA and anti-kappa antisera, thus establishing the identity of the two tumors. The reverse pattern of involvement, i.e., Waldeyer's ring tumor following gastrointestinal lymphoma, provides evidence against the concomitant primary or swallowing theories. The homing tendencies of gut-associated lymphoid tissue may offer some explanations for this interesting coincidence.