S4291 An Extremely Rare Presentation of Lymphoma Causing Mechanical Oropharyngeal Dysphagia: A Case Report

Introduction: Lymphomas constitute the third most common malignant tumors of the oral cavity, following squamous cell carcinoma and salivary gland neoplasms. However, primary lymphoma arising in the tongue base remains exceptionally rare. Given the atypical nature of this presentation, clinicians must maintain a high index of suspicion when evaluating tongue base lesions. A comprehensive diagnostic approach, including clinical examination, imaging, and histopathological evaluation, is crucial to ensure early diagnosis and therapy. Case Description/Methods: An 87-year-old Vietnamese-speaking woman with a history of hypertension and osteoarthritis presented with a rapidly enlarging tongue base lesion over 1 month, leading to progressive dysphagia and significant dietary restriction. She denied smoking or alcohol consumption. On examination, a large, exophytic, smooth, broad-based, non-ulcerated mass was observed at the right base of the tongue, without palpable cervical lymphadenopathy. Initial laboratory investigations were unremarkable. Bedside nasopharyngolaryngoscopy revealed a mass extending into the vallecula, obstructing visualization of the supraglottic and glottic structures. Computed tomography angiography of the neck demonstrated a large, heterogeneously enhancing mass at the tongue base, causing complete effacement of the oropharyngeal airway, with associated pathologic cervical lymphadenopathy. Staging computed tomography of the chest, abdomen, and pelvis showed no evidence of systemic metastasis. Histopathological analysis of a biopsy specimen confirmed diffuse large B-cell lymphoma (DLBCL), germinal center subtype, with fluorescence in situ hybridization revealing Bcl-6 positivity and negative Bcl-2 and Myc expression. Bone marrow biopsy was negative for lymphomatous involvement. The patient was staged as Ann Arbor II DLBCL, with a CNS International Prognostic Index (IPI) score of 3. Given the extent of airway compromise, a tracheostomy and percutaneous endoscopic gastrostomy tube were placed. Systemic chemotherapy was initiated with the Rituximab-mini-CHOP regimen. After 3 cycles, significant tumor regression was observed, with clinical improvement in dysphagia. Discussion: This case highlights an exceptionally rare presentation of DLBCL involving the tongue base, emphasizing the need for clinicians to consider lymphoma in patients with atypical oropharyngeal masses. A multidisciplinary approach involving early histopathological evaluation and targeted therapy is paramount in achieving favorable clinical outcomes.