Clinical Study Of Extranodal Lymphoma In The Head And Neck

Objective:The retrospective analysis of the clinical features,treatment and efficacy of patients with head and neck extranodal lymphoma aims to improve the understanding of otolaryngologists about the disease,so as to reduce the misdiagnosis rate and achieve early diagnosis and early treatment.Methods:The clinical data of patients with extranodal lymphoma in the head and neck admitted to the Department of Otorhinolaryngology of the Second Hospital of Shanxi Medical University from January 2020 to December 2022 were collected,and retrospective analysis was conducted to explore their clinical features and survival clinical data include sex,age at diagnosis,clinical manifestations,stage,signs,laboratory tests,imaging,histocyte morphology,immunohistochemical results,genetic and molecular biology,treatment options,and efficacy.SPSS 25.0 was used for statistical analysis of the data.Results:1.A total of 28 patients with head and neck extranodal lymphomas(ENLs)were included in this study,17 males and 11 females,with a male-to-female ratio of 1.55:1and a median age of 56(29-87)years.The median age at diagnosis differs depending on the primary site.The median age of nasal ENLs was 51(29-87)years,neck ENLs were60(44-74)years,and pharyngeal lymphatic ring ENLs were 62(43-79)years.2.The most common primary site of head and neck ENLs was the nasal cavity(n=14;50.0%),pharyngeal lymphatic ring(n=9;32.1%),neck(n=5;17.9%)。 The clinical manifestations of ENLs vary depending on the primary site.The main clinical manifestations of ENLs with primary nasal cavity were nasal congestion(71.4%),epistaxis(28.6%),and nasal swelling(21.4%).Among the lymphomas of the pharyngeal lymphatic ring,sore throat(44.4%)and pharyngeal discomfort(22.2%)were the main ones.Lymphoma in the neck is usually characterized by enlargement of the neck(80%).Of the 28 patients,6(21.4%)had fever.3.Among the 28 patients with ENLs,the pathological type of nasal ENLs was mostly NK/T-cell lymphoma(n=12;85.7%),while ENLs located in the pharyngeal lymphatic ring were mostly diffuse large B-cell lymphoma(n=5;55.6%)。4.Among the 14 patients with ENLs whose primary site was nasal,electronic computed tomography(CT)showed that the main invasion sites of the lesions were:ethmoid sinus(12 cases,85.7%),maxillary sinus(11 cases,78.6%),and mostly unilateral involvement.5.Excluding 9 patients who did not receive hospitalization,7(36.8%)patients(36.8%)of 19 hospitalized patients underwent surgery,of which 6(31.6%)patients underwent endoscopic nasal or pharyngeal mass resection,and 1(5.3%)patient underwent responsible vascular embolism.Eleven cases(57.9%)underwent chemotherapy combined with irradiation of the affected site.One patient(5.3%)received only involved site radiotherapy(ISRT).6.The median overall survival of 28 patients with head and neck ENLs was not reached.There were 19 patients with ENLs who were hospitalized,and 1 patient(5.3%)with Ann Arbor stage I,and the short-term efficacy assessment reached CR.There were10 patients(52.6%)in Ann Arbor stage II,4(21.1%)with PR,and 6(31.6%)with SD.There were 8(42.1%)patients in stage III-IV in Ann Arbor,3(15.8%)patients with PR,2(10.5%)with SD,and 3(15.8%)with PD.Conclusion:Head and neck extranodal lymphomas(ENLs)tend to occur in men,occur in the nasal cavity and are more common in middle-aged people,occur in pharyngeal lymph rings,and neck are more common in the elderly.Diagnosis of ENLs depends on histopathological biopsy,based on cell morphology,immunohistochemistry,genetics,and molecular biology.The early clinical manifestations of head and neck extranodal lymphoma have no obvious specificity,mostly compression symptoms caused by local swelling of the lesion and bleeding in the corresponding parts caused by invasion of blood vessels,and systemic symptoms such as fever occur in the late stage.The primary location of head and neck extranodal lymphoma differs depending on the pathological type.The pathological type of nasal ENLs was mostly NK/T-cell lymphoma,while ENLs located in the pharyngeal lymphatic ring were mostly diffuse large B-cell lymphoma.Patients with different stages of head and neck extranodal lymphoma have different treatment options.Early patients are mainly irradiated to the affected site,and advanced patients can choose chemotherapy combined with irradiation of the affected site.