Angiocentric T-cell lymphoma of the tonsil: a case report

We present a case of an angiocentric T-cell lymphoma (ACTL) occurring in a 31-year-old woman with the Acquired Immunodeficiency Syndrome (AIDS). This patient had oropharyngeal pain, a non-healing superficially ulcerated right tonsil, and no obvious tumor mass. Initial tonsillar biopsy revealed a subtle, non-specific, perivascular lymphocytic infiltrate subjacent to an ulcerated and inflamed mucosal lining. A benign, although atypical, inflammatory process was suspected. The distinctive features in this case include the relationship of ACTL to the Epstein-Barr Virus (EBV), which is usually related to B-cell lymphoproliferative disorders, the unique non-midline location of the lesion, and the relationship of ACTL to AIDS. ACTL appears to represent a unifying pathologic entity encompassing formerly described angioinvasive lymphoid lesions including polymorphic reticulosis, midline lethal granuloma, and lymphomatoid granulomatosis. We present these subtle histopathologic features to alert otolaryngologists who may encounter these cases, especially in AIDS patients who present extensive diagnostic possibilities. To the best of our knowledge, this is the first case report of ACTL involving the tonsil.