AN OROPHARYNGEAL ENIGMA :LYMPHOID HYPERPLASIA OF THE TONSIL AND TONGUE BASE

Background: Oral Lymphoproliferative disorder encompass a diverse group of conditions characterized by abnormal proliferation of lymphoid tissue within oral cavity and oropharynx. The etiology of Follicular Lymphoid Hyperpalsia could be any unknown antigenic response or a reactive action against chronic irritation. On Histopathology , the follicular variant is the commonest pattern that we see in the head and neck region. Case Presentation: we are presenting a case report of a patient aged 52 years with the complaints of difficulty in swallowing since 2 months, Known alcoholic and smoker for 10 years. Oropharynx had abnormally enlarged base of tongue.On Neck examination, 2 x 2 cm level 2 lymph node present on right side, firm in consistency , mobile, no warmth , no tenderness. Video diagnostic laryngoscopy showed Proliferative growth occupying base of tongue, Bilateral valeculae, Bilateral lateral glossoepiglotic fold ,lingual and laryngeal surface of epiglottis. Histopathology was suggestive of lymphoproliferative disorder/Granulomatous lesion. ImmunoHistoChemistry was Positive for CD20,CD3,Bcl-2,CD10,CD68,CD30, Ki -67 ,suggestive for Reactive follicular hyperplasia. Patient underwent Coblator Assisted tongue base reduction and tonsillectomy with epiglottopexy and elective tracheostomy. He was followed by two doses of Inj.Rituximab 500mg in 500ml Normal Saline in an interval of 3 months and planned for followup till 2 years. During the follow up, patient had symptoms of vomiting and diarrhoea for 20 days. Gastroenterology opinion was taken and patient developed B cell lymphoma in caecum and Maltoma in pylorus. Conclusion: The length of follow up necessary to provide an unequivocal distinction between Benign Lymphoid Hyperplasia and lymphoma is not known. Follicular lymphoid hyperplasia is a benign entity simulating malignant lesion ,follicular lymphoma. Every lymphoid hyperplasia should be considered malignant until unless their biopsy shows negative for 5 years.