(0749) Tonsillar Mantle Cell Lymphoma: Is Surgical Treatment Enough in Some Cases?

Introduction: Mantle cell lymphoma (MCL) is a rare subtype of non-Hodgkin lymphoma (NHL) of B cells, constituting approximately 3 to 10% of cases in adults. This lymphoma predominantly affects the lymph nodes, with the Waldeyer´s ring being one of the most commonly involved extranodal sites. However, despite its prevalence, the incidence of primary MCL in tonsils is low, and its documentation in scientific literature is limited.

Methods: We present a detailed clinical case of MCL localized in the right palatine tonsil. In February 2022, a 58 years old male presented with slowly progressive dysphonia, odynophagia, dysphagia to solids and weight loss of 9 kilograms in 6 months. No presence of fever, respiratory distress, or night sweats. We found an hypertrophic right tonsil, that obstructed 90% of the oropharynx. A CT Scan was performed, and the patient underwent tonsillectomy.

Results: A right-sided tonsillectomy was performed, yielding a specimen of 5x3 cm. Immunohistochemical results were positive for CD5, CD20, BCL 10, and CD79A, with focal positivity for cyclin D1, CD3 and CD30, and right tonsillar MCL was diagnosed. The patient was referred to oncology service,PET CT showed no evidence of disease and no coadyuvant treatment was prescribed. After two years follow-up, no recurrence is observed, the patient gained weight and remains asymptomatic.

Conclusions: MCL, although uncommon, should be considered in the differential diagnosis of tonsillar tumors, we had the debate between pathologists, if the tumor was MCL or Follicular Lymphoma. Immunohistochemistry and cyclin D as the Gold Standard are very important, to make tho correct diagnosis, and select the best treatment for our patients. The highlights of this case, is that the MCL was managed only with surgery and no evidence of regional or distant disease has been found on the two years follow up. MCL is considered a very agressive entity, however the literature review and this particular case, shows that Tonsillar MCL may behave differently, in a less agressive way, than the MCL found elsewere.

Key words: Mantle Cell Lymphoma, Tonsil, Non-Hodgkin Lymphoma.