Three Synchronous Primary Extranodal Mantle Cell Lymphomas Involving Torus Tubarius, Posterior Nasopharynx, and Base of the Tongue 65 Years After Treatment of Chronic Sinusitis with Nasopharyngeal Radium Irradiation
Diagnostic / therapeutic accidents, Rare disease
Andrew M. Plata, Robert E. Pollard, Yan Fang, Ahmed Khalid, Oscar C. Estalilla, Tomislav M. Jelic
Department of Pathology, Anatomy and Laboratory Medicine, School of Medicine, West Virginia University, Morgantown, WV, USA
Am J Case Rep 2019; 20:1063-1070
Radiation, specifically ionizing radiation, causes broad-spectrum gene damage, including double-strand DNA breaks, single DNA strand breaks, cross links, and individual base lesions, thus causing chromosomal translocations, deletions, point mutations, and, consequently, various types of cancer. Radiation also causes genomic instability in cells, which enhances the rate of mutations in the descendants of the irradiated cell after many generations of normal replications.
CASE REPORT: We report the first case of mantle cell lymphoma of the torus tubarius, and the first CD10-positive mantle cell lymphoma of the Waldeyer’s ring. Mantle cell lymphoma appeared 65 years after treatment of chronic sinusitis with nasopharyngeal radium irradiation.
CONCLUSIONS: On the basis of the medical literature about atomic bomb survivors, nuclear plant workers, and radiologists exposed to radiation, and our case, we conclude that radiation can, in a very small percentage of exposed individuals, cause non-Hodgkin lymphoma: in 0.24% of atomic bomb survivors and in at least 0.13% of the patients treated with nasopharyngeal radium irradiation.
Non-Hodgkin lymphoma can occur many decades after radiation exposure, and individuals treated with nasopharyngeal radium irradiation, usually in their childhood, need continuing follow-up.
Keywords: Eustachian Tube, Lymphoma, Mantle-Cell, Nasopharyngeal Neoplasms, Radium