Current issue
Journal content
Articles in press
Archive
About the Journal
About the Polish Annals of Medicine
Editorial Board
Open Access policy
Abstracting & indexing
Affiliated institutions
Contact
Instructions
Peer review process
Guide for authors
Publication ethics
Ethics and Patient Consent
User License
Usage of third party materials
Disclaimer
Reviewers
Guide for reviewers
List of reviewers
Review Form
CASE REPORT
A sinister mixed phenotype acute leukemia mimicking tonsil lymphoma
| 1 | Department of Otorhinolaryngology-Head Neck Surgery, School of Medical Sciences Universiti Sains Malaysia Health Campus, Malaysia |
| 2 | Department of Otorhinolaryngology, Hospital Raja Perempuan Zainab II, Kelantan, Malaysia |
| 3 | Department of Hematology and Transfusion Medicine Unit, School of Medical Sciences Universiti Sains Malaysia Health Campus, Malaysia |
| 4 | Hospital Universiti Sains Malaysia, Health Campus, Kota Bharu, Kelantan, Malaysia |
| 5 | Department of Pathology, School of Medical Sciences Universiti Sains Malaysia Health Campus, Malaysia |
CORRESPONDING AUTHOR
Norhafiza Mat Lazim
Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Health Campus 16150 Kubang Kerian, Kelantan, Malaysia. Tel.: +60199442664.
Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Health Campus 16150 Kubang Kerian, Kelantan, Malaysia. Tel.: +60199442664.
Submission date: 2022-02-06
Final revision date: 2022-03-14
Acceptance date: 2022-03-15
Online publication date: 2022-04-04
Pol. Ann. Med. 2023;30(1):58–62
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Unilateral tonsillar hypertrophy with accompanying cervical lymphadenopathy gives immediate suspicion of lymphoma or squamous cell carcinoma as the most probable diagnosis.
Aim:
We aim to highlight the role of diagnostic tonsillectomy for intact looking tonsil as opposed to incisional biopsy for obvious fungating mass or ulcerative lesion. We also emphasise not to overlook abnormal preliminary blood work up. If leukocytosis is present, a peripheral blood film must be done to rule out ongoing infection or a more cynical haematological disease.
Case study:
We report a case of a young female presenting with progressive dysphagia as well as bilateral neck swelling. Examination showed a unilateral tonsillar hypertrophy with bilateral cervical lymph nodes highly suggestive of tonsil lymphoma.
Results and discussion:
She was opted for tonsillectomy for both diagnostic as well as therapeutic purposes. Histopathological examination (HPE) of the left tonsil removed paired with an elaborated blood workup finally diagnosed her with a rare case of mixed phenotype acute leukemia.
Conclusions:
A multidisciplinary team approach and early intervention are crucial to arrive at the correct diagnosis allowing prompt treatment and better prognosis and symptomatic relief.
Unilateral tonsillar hypertrophy with accompanying cervical lymphadenopathy gives immediate suspicion of lymphoma or squamous cell carcinoma as the most probable diagnosis.
Aim:
We aim to highlight the role of diagnostic tonsillectomy for intact looking tonsil as opposed to incisional biopsy for obvious fungating mass or ulcerative lesion. We also emphasise not to overlook abnormal preliminary blood work up. If leukocytosis is present, a peripheral blood film must be done to rule out ongoing infection or a more cynical haematological disease.
Case study:
We report a case of a young female presenting with progressive dysphagia as well as bilateral neck swelling. Examination showed a unilateral tonsillar hypertrophy with bilateral cervical lymph nodes highly suggestive of tonsil lymphoma.
Results and discussion:
She was opted for tonsillectomy for both diagnostic as well as therapeutic purposes. Histopathological examination (HPE) of the left tonsil removed paired with an elaborated blood workup finally diagnosed her with a rare case of mixed phenotype acute leukemia.
Conclusions:
A multidisciplinary team approach and early intervention are crucial to arrive at the correct diagnosis allowing prompt treatment and better prognosis and symptomatic relief.
ACKNOWLEDGEMENTS
A special thanks to all the co-authors from the pathology and hematology for their contributions and to those who were actively involved in diagnosing this unique case. An extended warm gratitude for the hemato-oncologists as well for their prompt decisions in commencing the appropriate treatment for the patient.
FUNDING
None declared.
CONFLICT OF INTEREST
None declared.
REFERENCES (13)
1.
Skhoun H, Khattab M, Chebihi ZT, Belkhayat A, Dakka N, BaghdadI J EL. B/T mixed phenotype acute leukemia with high hyperdiploidy and lineage switch to B-cell acute leukemia. Leuk Res Reports. 2022;17:100289. https://dx.doi.org/10.1016%2Fj....
2.
Krause JR, Findeis S. Mixed phenotypic acute leukemia. Baylor Univ Med Cent Proc. 2018;31(1):90–91. https://dx.doi.org/10.1080%2F0....
3.
Dolev Y, Daniel SJ. The presence of unilateral tonsillar enlargement in patients diagnosed with palatine tonsil lymphoma: Experience at a tertiary care pediatric hospital. Int J Pediatr Otorhinolaryngol. 2008;72(1):9–12. https://doi.org/10.1016/j.ijpo....
4.
Taziki MH, Azarhoush R, Taziki MM. Clinical Evaluation of the Tonsils for Malignancy: The Necessity of Histopathological Examination. Med Lab J. 2018;12(1):27–30. http://dx.doi.org/10.29252/mlj....
5.
Mohammadianpanah M, Omidvai S, Mosalei A, Ahmadloo N. Treatment results of tonsillar lymphoma: A 10-year experience. Ann Hematol. 2005;84(4):223–226. https://doi.org/10.1007/s00277....
6.
EI-Naggar AK, Chan JKC, Grandis JR, Takata T. Slootweg PJ, eds. WHO/IARC Classification of Head and Neck Tumours. 4th Ed. Lyon: IARC; 2017.
7.
Watkinson J, Gilbert R, eds. Stell and Maran’s Textbook of Head and Neck Surgery and Oncology. 5th Edit. Arnold (London): CRC Press; 2012.
8.
Hyams VJ. Differential diagnosis of neoplasia of the palatine tonsil. Clin Otolaryngol Allied Sci. 1978;3(2):117–126. https://doi.org/10.1111/j.1365....
9.
Bruneau J, Molina TJ. WHO Classification of Tumors of Hematopoietic and Lymphoid Tissues. In: Molina TJ, eds. Hematopathology. Encyclopedia of Pathology. Cham: Springer; 2020. https://doi.org/10.1007/978-3-....
10.
Weinberg O. Mixed phenotype acute leukemia (MPAL). Atlas Genet Cytogenet Oncol Haematol. 2018;22(7):292–294. https://doi.org/10.4267/2042/6....
11.
Wolach O, Stone RM. How I treat mixed-phenotype acute leukemia. Blood. 2015;125(16):2477–2485. https://doi.org/10.1182/blood-....
12.
Wang P, Peng X, Deng X, Gao L, Zhang X, Feng Y. Diagnostic challenges in T-lymphoblastic lymphoma, early T-cell precursor acute lymphoblastic leukemia or mixed phenotype acute leukemia: A case report. Med (United States). 2018;97(41):e12743. https://doi.org/10.1097/md.000....
13.
Monabati A, Safaei A, Nouri S, Safavi M, Solhjoo F. A rare case of extramedullary T/myeloid mixed phenotype acute leukemia with t(1;5)(q23;q33). Case Rep Pathol. 2016;2016(d):1–3. https://doi.org/10.1155/2016/8....
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.