Tonsil lymphoma presenting as tonsillitis after bone marrow transplantation

Area of Science:

• Oncology
• Hematology
• Immunology

Background:

• Bone marrow transplantation (BMT) is a successful leukemia treatment, but causes severe immunosuppression.
• Immunosuppression post-BMT increases the risk of secondary neoplastic disorders.
• Post-transplant lymphoproliferative disorders are a known complication, particularly in T-cell-depleted BMT.

Purpose of the Study:

• To report a series of patients who developed non-Hodgkin's lymphoma (NHL) in the tonsillar region after T-cell-depleted BMT.
• To highlight the clinical presentation of NHL mimicking infectious pharyngitis/tonsillitis in this patient population.
• To alert clinicians to consider lymphoma in post-BMT patients with persistent throat symptoms.

Main Methods:

• Retrospective case series of six patients treated at Memorial Sloan-Kettering Cancer Center (October 1990-October 1992).
• Patients underwent T-cell-depleted BMT for leukemia.
• Diagnosis of NHL was confirmed via histopathologic review of tonsillectomy and/or cervical lymph node biopsies.

Main Results:

• Six patients developed tonsillar region NHL within 5 months post-T-cell-depleted BMT.
• Initial symptoms mimicked infectious pharyngitis/tonsillitis, unresponsive to medical therapy.
• Histopathology confirmed NHL; Epstein-Barr virus association was noted in five patients.
• Persistent pharyngitis/tonsillitis, cervical lymphadenopathy, and odynophagia were key indicators.

Conclusions:

• Persistent pharyngitis/tonsillitis after T-cell-depleted BMT can be a sign of non-Hodgkin's lymphoma.
• Early consideration and biopsy are crucial for timely diagnosis and management.
• Epstein-Barr virus may play a role in the pathogenesis of these post-transplant lymphomas.