Journal Reading

Limfoma Primer Laring: Laporan Kasus dan Tinjauan Literatur

Dibacakan oleh :
Leonardus Bayu Agung Prakoso
17014101010

Masa KKM :18 September 2017 15 Oktober 2017

Pembimbing :

Dr. dr. O.C.P. Pelealu, Sp.THT-KL (K)

BAGIAN THT-KL
FAKULTAS KEDOKTERAN
UNIVERSITAS SAM RATULANGI
MANADO
2017

LEMBAR PENGESAHAN

Journal Reading yang berjudul

Limfoma Primer Laring: Laporan Kasus dan Tinjauan Literatur

telah dibacakan pada September 2017.

Oleh:

Leonardus Bayu Agung Prakoso

17014101010
Masa KKM:18 September 2017 15 Oktober 2017
 Pembimbing,

Dr. dr. O.C.P. Pelealu, Sp.THT-KL (K)

Open Journal of Clinical Diagnostics, 2015, 5, 81-85
Published Online June 2015 in SciRes. http://www.scirp.org/journal/ojcd
http://dx.doi.org/10.4236/ojcd.2015.52015

Primary Lymphoma of the Larynx: A Case

Report and Literature Review
Khaled Khamassi1, Madiha Mahfoudhi2*, Habib Jaafoura1, Khaoula Ouertani1,
Wafa Kaabachi1, Lobna Bougacha1, Rim Lahiani1, Mamia Ben Salah1
1
Department of OtorhinolaryngologyHead and Neck Surgery, Charles Nicolle Hospital, Tunis, Tunisia
2
Department of Internal Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
Email: *madiha_mahfoudhi@yahoo.fr

Received 15 April 2015; accepted 7 June 2015; published 10 June 2015

Copyright 2015 by authors and Scientific Research Publishing Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY).
http://creativecommons.org/licenses/by/4.0/

Abstract
Background: Primary non-hodgkin lymphoma of the larynx is a rare entity accounting for 1% of
laryngeal tumors. Fewer than 100 cases have been reported in the literature. Case presentation: A
52-year-old man, presented with a two-month history of dysphonia. Nasofibroscopy showed left
submucosal bulging of the laryngeal supraglottic floor. Cervical computed tomography showed
extensive left supraglottic mass, with partial lysis of the thyroid cartilage. Direct laryngoscopy
showed left submucosal bulging of the supraglottic floor. Transmucosal biopsies were performed.
Histological study concluded to the presence of a diffuse large-cell B lymphoma. The patient was
treated with chemotherapy followed by external radiotherapy. Evolution was favourable. Conclu-
sion: Although primary laryngeal non-hodgkin lymphoma is rare, it should be considered in the
differential diagnosis of a mass in the neck region, especially in the supraglottic area. Direct la-
ryngoscopy with biopsy makes the diagnosis. Treatment and prognosis depend on the stage and
the grade of the lymphoma.

Keywords
Larynx, Lymphoma, Laryngoscopy, Chemotherapy, Radiotherapy

1. Introduction
Primary non-Hodgkin lymphoma (NHL) most frequently arises in the gastrointestinal tract, and the head and
neck is the second most frequent region [1]. Most head and neck lymphomas arise within the Waldeyer ring, but
extranodal extralymphatic sites still accounted for 25% of these tumors. Laryngeal localization is rare, account-
ing for 1% of laryngeal tumors. Fewer than 100 cases have been reported in the literature. Although 90% of
How to cite this paper: Khamassi, K., Mahfoudhi, M., Jaafoura, H., Ouertani, K., Kaabachi, W., Bougacha, L.,
Lahiani, R. and
Salah, M.B. (2015) Primary Lymphoma of the Larynx: A Case Report and Literature Review. Open Journal of
Clinical Diag-nostics, 5, 81-85. http://dx.doi.org/10.4236/ojcd.2015.52015
 K. Khamassi et al.

tumors involving the larynx are squamous cell carcinoma, laryngeal lymphoma is an important

differential con-sideration because lymphoma is treated with chemo-radiation instead of

surgery. Early symptoms are subtle and nonspecific, and confirmation of the diagnosis is

often difficult. Early detection of lymphoma allows improved patient care and may result

in decreased dissemination of the disease process.

The aim of this study is to report a rare case of primary laryngeal lymphoma, and, with a

review of the litera-ture, to precise clinical and paraclinical features and also therapeutic

modalities of this aggressive lesion.

2. Case Report

A 52-year-old man, 15-pack-year smoker and nonalcoholic, presented to our outpatient clinic with a

two month history of dysphonia, without dyspnea. Physical examination revealed a left paramedical

neck swelling measur-ing 3 cm of long axis, with healthy skin and no lymphadenopathy.

Nasofibroscopy showed left submucosal bulging of the laryngeal supraglottic floor.

Cervical computed tomography showed extensive left supraglottic mass, measuring 37 32 mm,

with partial lysis of the thyroid cartilage (Figure 1 & Figure 2).

A direct laryngoscopy under general anesthesia was performed, showing left submucosal bulging

of the su-praglottic floor (Figure 3). Transmucosal deep biopsies were performed. Histological

examination showed infil-tration by large atypical lymphoid cells with irregular nuclear outlines and

multiple prominent nucleoli. Numer-ous mitotic and apoptotic cells were present (Figure 4). On

immunohistochemistry, the cells were positive for CD45 and CD20 and negative for CD3 and bcl2

on. Diagnosis of diffuse large-cell B lymphoma of the larynx was retained.

Figure 1. Computed CT (axial): Extensive left suprag-

lottic mass with partial lysis of the thyroid cartilage.

Figure 2. Computed CT (coronal): Extensive left su-

praglottic mass.
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Khamas
si et al.

Figure 3. Direct laryngoscopy: Left submucosal bulg-

ing of the supraglottic floor.

Figure 4. Diffuse large-cell B lymphoma.

Staging with thoraco-abdominal CT and bone marrow biopsy showed no evidence of disease
involvement outside of the larynx. Biological investigations showed a normal blood cell count and a
normal lactate dehydro-genase level.
These findings were consistent with a diagnosis of diffuse large B-cell (high-grade) NHL of the
larynx, with Ann-Arbor stage IE. The patient was treated according to R-CEOP regimen, which is a
mixture of rituximab and several chemotherapy drugs. These ones included cyclophosphamide,
etoposide, vincristine and prednisone. Three cycles were administrated. Three cycles of this regimen
were administrated. The chemotherapy was fol-low by consolidation external radiation therapy at the
dose of 40 Gy on the neck region. No complications of treatment were noted. Evolution was favourable
with no signs of local recurrence. Follow-up period was 3 years.

3. Discussion
The most common extranodal head and neck sites of primary non-Hodgkin lymphoma are the paranasal
sinuses, the salivary glands, and the thyroid gland [2]. The larynx is a very rare site for these tumors.
The low occurrence rate is due to the relatively low lymphoid content in the larynx when compared to
other areas in the respiratory tract.
NHL is presumed to arise from 2 locations within the larynx: from aggregates of specialized
lymphoid tissue in the submucosa, predominantly of B-cell lineage, or from MALT (Mucosal
Associated Lymphoid Tissue) in the aryepiglottic folds and epiglottis [3]. Fewer than 100 cases of
lymphoproliferative tumors arising from the larynx (including both NHL and immuno-suppression-
related lymphoproliferative diseases) have been pre-viously reported in the literature [4].
 The mean age at diagnosis is 70 years, with a range from 4 to 81 years. Sex-ratio has been reported to
be va-riable in different series [5] [6]. Our patient was a 52-year-old male.
Symptoms of NHL are typically site- specific and thus have manifestations similar to those produced
by epi-thelial carcinomas in the same location. These typically include dysphonia, hoarseness,
dysphagia, and cervical lymphadenopathy [7]-[9]. Only dysphonia was present in our patient. Systemic
symptomatology is unusual, since laryngeal lymphomas tend to remain localized for prolonged periods,
though more aggressive forms tend
83
K. Khamassi et al.

to spread earlier [10]. Interestingly, these tumors usually spread to other mucosal sites such as
bowel, lung, and orbit rather than nodal sites [7] [8].
In our case, just only a submucosal bulging has suggested the presence of a laryngeal tumor. The
literature re-view shows that all sites inside the larynx can be involved. The commonest anatomical
site is the supraglottic region (47%). Glottic involvement is accounting for 25% of cases. Paraglottic
and subglottic regions are much less commonly affected. Macroscopically, these tumors present as
smooth or polypoid masses rather than ulce-rated masses [10].
There are certain imaging characteristics that should suggest lymphoma. A large non-necrotic
supraglottic le-sion with a submucosal component that demonstrates homogeneous enhancement is
more characteristic of lym-phoma than of squamous cell carcinoma [4]. Laryngeal lymphoma is
commonly seen to extend into the laryn-geal cartilages, the hypopharynx and the oropharynx. In our
patient, partial lysis of the thyroid cartilage was found. Calcifications are not seen with laryngeal
lymphoma. Cervical lymphadenopathy, a common finding in supraglottic squamous cell carcinoma,
is seen in a smaller percentage of patients with laryngeal lymphoma.
In fact, both macroscopic and radiological appearances of a large laryngeal tumour with a
supraglottic sub-mucosal component should alert to the possibility of laryngeal lymphoma [5] [6].
Histologically, primary laryngeal lymphoma is more commonly of B- cell origin, though some T-
cell and NK-cell lymphomas may be found. The latter are more difficult to diagnose and usually
require deep and sometimes repeated biopsy. The unique feature of lymphomas is the fact that these
are considered as clonal proliferation of lymphocytes arrested at different stages of differentiation.
Immunohistochemistry with various antibodies iden-tifies the specific lineage and the
developmental stage. A panel of markers is used, which includes leukocyte common antigen (LCA),
B-cell markers (CD20 and CD79a), T-cell markers (CD3 and CD5) and other markers like CD23,
bcl-2 and CD10.
It is imperative to stage the lymphomatous process correctly, since treatment varies depending on
both the grade and the stage of the disease. PET-CT, in particular, is finding an important place for
radiological staging in laryngeal lymphoma, both for low-grade and high-grade ones [11].
The main modalities of treatment were radiotherapy alone or in combination with chemotherapy
[12]-[15]. For our patient we opted for 3 cycles of R-CEOP followed by external radiotherapy.
Surgical intervention, based on tracheotomy or on laser debulking, is only usually required in
patients presenting with acute airway obstruc-tion [10] [13] [16]. Combined chemo-radiotherapy,
seems to be the preferred modality of treatment, especially for high-grade lymphomas, and provides
an excellent outcome [10] [12] [13] [17].

4. Conclusion
Although primary laryngeal lymphoma is rare, it should be considered in the differential diagnosis
of a mass in the neck region, especially in the supraglottic area. Computed tomography is very
important to evaluate the local extension. Direct laryngoscopy with biopsy makes the diagnosis.
Treatment and prognosis depend on the stage and the grade of the lymphoma.

Conflict of Interest
There are no conflicts of interest.

References
[1] Ezzat, A.A., Ibrahim, E.M., El Weshi, A.N., Khafaga, Y.M., AlJurf, M., Martin, J.M., et al. (2001)
Localized Non-Hodgkins Lymphoma of Waldeyers Ring: Clinical Features, Management, and
Prognosis of 130 Adult Patients. Head Neck, 23, 547-558. http://dx.doi.org/10.1002/hed.1077
[2] Pak, M.V., Woo, J.K.S. and van Hasselt, C.A. (1999) T-Cell Non-Hodgkins Lymphoma of the Larynx
and Hypopha-rynx. OtolaryngologyHead and Neck Surgery, 121, 335-336.
http://dx.doi.org/10.1016/S0194-5998(99)70203-2
[3] Zapparoli, M., Trolese, A.R., Remo, A., Sina, S., Bonetti, A. and Micheletto, C. (2014) Subglotic Malt-
Lymphoma of the Larynx: An Unusual Presentation of Chronic Cough. International Journal of
Immunopathology and Pharmacolo-gy, 27, 461-465.
[4] King, A.D., Yuen, E.H., Lei, K.I., Ahuja, A.T. and Van Hasselt, A. (2004) Non-Hodgkin Lymphoma of
the Larynx: CT and MR Imaging Findings. AJNR American Journal of Neuroradiology, 25, 12-15.
[5] Ansell, S.M., Habermann, T.M., Hoyer, J.D., Strickler, J.G., Chen, M.G. and McDonald, T.J. (1997)
Primary
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Laryngeal Lymphoma. The Laryngoscope, 107, 1502-1506. http://dx.doi.org/10.1097/00005537-199711000-

00014
[6] Azzopardi, C.P., Degaetano, J., Betts, A., Farrugia, E., Magri, C., Refalo, N., et al. (2014) Laryngeal
Lymphoma: The
High and Low Grades of Rare Lymphoma Involvement Sites. Case Reports in Medicine, 2014, Article
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[7] Yilmaz, M., Ibrahimov, M., Mamanov, M., Rasidov, R. and Oktem, F. (2012) Primary Marginal Zone B-Cell
Lym-phoma of the Larynx. Journal of Craniofacial Surgery, 23, e1-e2.
http://dx.doi.org/10.1097/SCS.0b013e318242055a
[8] Salazar Guilarte, J.X., Sancho Mestre, M. and Gras Albert, J.R. (2012) Laryngeal Manifestation of B-Cell Non-
Hodgkin Lymphoma. Acta Otorrinolaringolgica Espaola, 63, 485-487.
http://dx.doi.org/10.1016/j.otorri.2011.04.007
[9] Desai, S.C., Allen, C., Chernock, R. and Haughey, B. (2011) Pathology Quiz Case 1. Primary Diffuse Large
B-Cell Lymphoma of the Larynx. Archives of OtolaryngologyHead & Neck surgery, 137, 526,528.
[10] Markou, K., Goudakos, J., Constantinidis, J., Kostopoulos, I., Vital, V. and Nikolaou, A. (2010) Primary
Laryngeal Lymphoma: Report of 3 Cases and Review of the Literature. Head & Neck, 32, 541-549.
[11] Zhao, K., Luo, Y.Z., Zhou, S.H., Dai, B.L., Luo, X.M., Yan, S.X., et al. (2012) 18F-Fluorodeoxyglucose
Positron Emission Tomography/Computed Tomography Findings in Mucosa-Associated Lymphoid Tissue
Lymphoma of the Larynx: A Case Report and Literature Review. The Journal of International Medical
Research, 40, 1192-1206. http://dx.doi.org/10.1177/147323001204000340
[12] Stephenson, K., Peer, S., Govender, D. and Fagan, J.J. (2013) Plasmablastic Lymphoma of the Larynx:
Report of Two Cases. The Journal of Laryngology & Otology, 127, 96-99.
http://dx.doi.org/10.1017/S0022215112002149
[13] Elmazghi, A., Elkacemi, H., Lalya, I., Zaidi, H., Harmouch, A., Kanouni, L., et al. (2011) Primary Malignant
Non-Hodgkin Lymphoma of the Larynx: Report of a Case. Pan African Medical Journal, 9, 17.
http://dx.doi.org/10.4314/pamj.v9i1.71192
[14] Roca, B., Vidal-Tegedor, B. and Moya, M. (2005) Primary Non-Hodgkin Lymphoma of the Larynx. Southern
Medical Journal, 98, 388-389. http://dx.doi.org/10.1097/01.SMJ.0000129938.97092.5F
[15] Word, R., Urquhart, A.C. and Ejercito, V.S. (2006) Primary Laryngeal Lymphoma: Case Report. Ear Nose &
Throat Journal, 85, 109-111.
[16] Paleri, V., Stafford, F.W. and Sammut, M.S. (2005) Laser Debulking in Malignant Upper Airway Obstruction.
Head & Neck, 27, 296-301. http://dx.doi.org/10.1002/hed.20153
[17] Cavalot, A.L., Preti, G., Vione, N., Nazionale, G., Palonta, F. and Fadda, G.L. (2001) Isolated Primary Non-
Hodgkins Malignant Lymphoma of the Larynx. The Journal of Laryngology & Otology, 115, 324-326.
http://dx.doi.org/10.1258/0022215011907325
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 Open Journal of Clinical Diagnostics, 2015, 5, 81-85
Diterbitkan online Juni 2015 di SciRes.
http://www.scirp.org/journal/ojcd
http://dx.doi.org/10.4236/ojcd.2015.52015

Limfoma Primer Laring: Laporan

Kasus dan Tinjauan Literatur
Khaled Khamassi1, Madiha Mahfoudhi2 *, Habib Jaafoura1, Khaoula
Ouertani1, Wafa Kaabachi1, Lobna Bougacha1, Lingkar Lahiani1,
Mamia Ben Salah1
1
Departemen Otorhinolaryngology-Head and Neck Surgery, Rumah Sakit Charles Nicolle, Tunis,
Tunisia
2
Departemen Internal Medicine A, Rumah Sakit Charles Nicolle, Tunis, Tunisia
Email: *madiha_mahfoudhi@yahoo.fr

Menerima 15 April 2015; diterima Juni 2015 7; diterbitkan 10

Juni 2015 Copyright 2015 oleh penulis dan Penelitian
Ilmiah Publishing Inc.
Karya ini dilisensikan di bawah lisensi Creative Commons Atribusi Internasional (CC BY).
http://creativecommons.org/licenses/by/4.0/

Abstrak
Latar Belakang: Limfoma non hodgkin primer pada laring adalah keadaan langka yang
terhitung 1% dari tumor laring. Kurang dari 100 kasus telah dilaporkan dalam
literatur. Presentasi Kasus: Seorang pria 52 tahun, dengan riwayat dysphonia selama 2
bulan. Nasofibroskopi menunjukkan submukosa menonjol pada dinding supraglottic
laring. Tomografi servical menunjukkan massa supraglottic kiri yang luas, dengan lisis
sebagian kartilago tiroid. Laringoskopi langsung menunjukkan tonjolan submukosa
kiri pada dinding supraglottic. Biopsi transmukosa dilakukan. Studi histologis
menyimpulkan adanya limfoma sel B besar yang menyebar. Pasien diobati dengan
kemoterapi diikuti dengan radioterapi eksternal. Perubahan itu menguntungkan.
Kesimpulan: Meskipun limfoma non-Hodgkin laring jarang terjadi, harus
dipertimbangkan dalam diagnosis banding massa di daerah leher, terutama di daerah
supraglotis. Laringoskopi langsung dengan biopsi menegakkan diagnosis. Pengobatan
dan prognosis tergantung pada stadium dan kelas dari limfoma.

Kata kunci
Laring, Limfoma, Laringoskopi, Kemoterapi, Radioterapi
1. Perkenalan
Limfoma non-hodgin Primer paling sering muncul di saluran pencernaan, dan kepala dan leher
adalah wilayah yang paling sering kedua [1]. Sebagian besar limfoma kepala dan leher timbul di
dalam cincin Waldeyer, tapi ekstralimfatik ekstranodal masih terhitung 25% dari tumor ini.
Lokalisasi laring jarang terjadi, terhitung 1% dari tumor laring. Kurang dari 100 kasus telah
dilaporkan dalam literatur. Meskipun 90%
 Bagaimana mengutip tulisan ini: Khamassi, K., Mahfoudhi, M., Jaafoura, H., Ouertani, K., Kaabachi, W.,
Bougacha, L., Lahiani, R. dan
Salah, MB (2015) Primer Limfoma dari Laring: Laporan Kasus dan Studi Literatur. Open Journal of Clinical Diag-
nostics, 5, 81-85.http://dx.doi.org/10.4236/ojcd.2015.52015

K. Khamassi et al.

tumor yang melibatkan laring adalah karsinoma sel skuamosa, limfoma laring adalah salah satu
pertimbangan penting karena limfoma diobati dengan kemoterapi radiasi bukan operasi. Gejala
awal tidak kentara dan non spesifik, dan konfirmasi diagnosis seringkali sulit. Deteksi dini limfoma
memungkinkan peningkatan perawatan pasien dan dapat mengakibatkan penurunan diseminasi
dari proses penyakit.
Tujuan dari penelitian ini adalah untuk melaporkan kasus limfoma laring primer yang jarang
terjadi, dan dengan tinjauan literatur terhadap gambaran klinis dan paraklinis yang tepat dan juga
modalitas terapi dari lesi agresif ini.

2. Laporan Kasus
Pria 52 tahun, perokok 15 pack per tahun dan non-alkohol, datang ke klinik rawat jalan kami
dengan riwayat dua bulan disfonia, tanpa dyspnea. Pemeriksaan fisik menunjukkan pembengkakan
leher paramedis kiri dengan panjang 3 cm, dengan kulit yang sehat dan tidak ada limfadenopati.
Nasofibrokopi menunjukkan bulatan submukosa menonjol dari dinding supraglottic laring.
Tomografi servical menunjukkan massa supraglottic yang lebar, berukuran 37 32 mm, dengan
lisis parsial dari tulang rawan tiroid (Gambar 1 & Gambar 2).
Laringoskopi langsung di bawah anestesi umum dilakukan, menunjukkan goresan submukosa kiri
dinding supraglottic (Gambar 3). Biopsi dalam radiologi transmukosa dilakukan. Pemeriksaan
histologis menunjukkan infiltrasi oleh sel-sel limfoid atipikal yang besar dengan garis besar tidak
teratur dan beberapa nukleolus menonjol. Banyak sel mitosis dan apoptosis didapatkan (Gambar
4). Pada imunohistokimia, sel-sel positif untuk CD45 dan CD20 dan negatif untuk CD3 dan Bcl2.
Diagnosis limfoma sel B besar yang menyebar dipertahankan.

Gambar 1. Computed CT (aksial): Extensive suprag- kiri

massa lottic dengan lisis sebagian dari kartilago tiroid.
Gambar 2. Computed CT (coronal): Extensive su kiri
massa praglottic.
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Khamas
si et al.

Gambar 3. laringoskopi: Left submukosa bulg-

ing dari lantai supraglottic.

Gambar 4. Berdifusi B limfoma sel besar.

Stadium dengan CT toraks abdomen dan biopsi sumsum tulang menunjukkan tidak ada bukti
keterlibatan penyakit penyerta di luar laring. Pemeriksaan biologi menunjukkan jumlah sel darah
normal dan tingkat dehidrogenase laktat normal.
Temuan ini konsisten dengan diagnosis penyebaran sel B besar (high-grade) NHL laring, dengan
tanpa Ann Arbor IE. Pasien diobati menurut R-CEOP rejimen, yang merupakan campuran rituximab dan
beberapa obat kemoterapi. Yang ini termasuk siklofosfamid, etoposida, vincristine dan prednisone.
Tiga siklus regimen ini yang diadministrasikan. Kemoterapi diikuti dengan konsolidasi terapi radiasi
eksternal pada dosis 40 Gy pada daerah leher. Tidak ada komplikasi pengobatan yang dicatat. Evolusi
sangat menguntungkan tanpa tanda-tanda kekambuhan lokal. Follow up sudah 3 tahun.

3. Diskusi
Bagian kepala dan leher yang paling umum dari limfoma non-Hodgkin primer adalah sinus paranasal,
kelenjar ludah, dan kelenjar tiroid [2]. Laring adalah tempat yang sangat jarang untuk tumor ini.
Tingkat kejadian rendah disebabkan oleh kandungan limfoid yang relatif rendah di laring bila
dibandingkan dengan daerah lain pada saluran pernapasan.
 NHL diperkirakan timbul dari 2 lokasi dalam laring: dari agregat jaringan limfoid khusus di
submukosa, terutama garis keturunan sel B, atau dari MALT (Mukosa Associated Lymphoid Tissue) di
lipatan aryepiglottic dan epiglotis [3]. Kurang dari 100 kasus tumor lymphoproliferative timbul dari
laring (termasuk NHL dan immunosupresi terkait penyakit limfoproliferatif) telah dilaporkan
sebelumnya dalam literatur [4].
Usia rata-rata pada saat diagnosis adalah 70 tahun, dengan rentang 4-81 tahun. Sex-rasio telah
dilaporkan va-riable dalam seri yang berbeda[5] [6]. Pasien kami adalah laki-laki 52 tahun.
Gejala NHL biasanya bersifat spesifik dan memiliki manifestasi yang serupa dengan yang dihasilkan
oleh karsinoma epitel di lokasi yang sama. Hal ini biasanya mencakup disfonia, suara serak, disfagia,
dan limfadenopati servikal[7] - [9]. Hanya dysphonia yang hadir pada pasien kami. Gejala sistemik tidak
biasa, karena limfoma laring cenderung tetap terlokalisasi untuk waktu yang lama, meskipun bentuk
yang lebih agresif cenderung
 83
K. Khamassi et al.

untuk menyebar lebih awal [10]. Menariknya, tumor ini biasanya menyebar ke situs mukosa lain
seperti usus, paru-paru, dan orbit daripada situs nodal [7] [8].
Dalam kasus kami, hanya lipatan submukosa yang menunjukan adanya tumor laring. Tinjauan
literatur menunjukkan bahwa semua situs dalam laring dapat terlibat. Situs anatomi yang paling
umum adalah wilayah supraglottic (47%). Keterlibatan glotis adalah mencakup 25% kasus. Daerah
Paraglottic dan subglottic yang lebih jarang terkena. Makroskopik, tumor ini hadir sebagai massa
polipoid halus atau daripada massa ulet[10].
Ada karakteristik pencitraan tertentu yang harus menyarankan limfoma. Lesi supraglottic
nonkrotik yang besar dengan komponen submukosa yang menunjukkan peningkatan homogen
lebih karakteristik limfoma dari pada karsinoma sel skuamosa[4]. Laring limfoma biasanya terlihat
meluas ke dalam tulang rawan laring, kartilago hipofaring dan orofaring. Dalam pasien kami, lisis
parsial dari tulang rawan tiroid ditemukan. Kalsifikasi tidak terlihat dengan limfoma laring.
limfadenopati servikal, umum ditemukan pada karsinoma sel skuamosa supraglottic, terlihat dalam
persentase yang lebih kecil dari pasien dengan limfoma laring.
Bahkan, kedua penampilan makroskopik dan radiologi dari tumor laring yang besar dengan
komponen sub-mukosa supraglottic harus waspada terhadap kemungkinan limfoma laring [5] [6].
Secara histologis, limfoma laringeal primer lebih sering terjadi dari asal sel B-, meskipun
beberapa T-sel dan NK-sel limfoma dapat ditemukan. Yang terakhir lebih sulit untuk mendiagnosa
dan biasanya membutuhkan biopsi yang mendalam dan kadang berulang. Fitur unik dari limfoma
adalah kenyataan bahwa ini dianggap sebagai proliferasi klonal limfosit ditangkap pada berbagai
tahap diferensiasi yang berbeda. Imunohistokimia dengan berbagai antibodi mengidentifikasi garis
keturunan spesifik dan tahap perkembangan. Sebuah panel penanda yang digunakan, yang
meliputi antigen umum leukosit (LCA), marker B-cell (CD20 dan CD79a), spidol T-sel (CD3 dan CD5)
dan penanda lain seperti CD23, bcl-2 dan CD10.
Sangat penting untuk mengolah proses limfomatosa dengan benar, karena pengobatan
bervariasi tergantung pada kedua kelas dan tahap penyakit. PET-CT, khususnya, adalah menemukan
tempat yang penting untuk stadium radiologi di limfoma laring, baik untuk kelas rendah dan yang
bermutu tinggi[11].
Modalitas utama pengobatan adalah radioterapi saja atau dikombinasikan dengan kemoterapi
[12] - [15].Untuk pasien kami kami memilih untuk 3 siklus R-CEOP diikuti oleh radioterapi eksternal.
intervensi bedah, berdasarkan tracheostomy atau pada laser debulking, biasanya hanya diperlukan
pada pasien yang mengalami obstruksi jalan nafas akut [10] [13] [16]. Kombinasi kemo-radioterapi,
tampaknya menjadi modalitas pilihan pengobatan, terutama untuk limfoma bermutu tinggi, dan
memberikan hasil yang sangat baik [10] [12] [13] [17].

4. Kesimpulan
Meskipun limfoma laring primer jarang terjadi, harus dipertimbangkan dalam diagnosis banding
massa di daerah leher, terutama di daerah supraglottic. Tomography sangat penting untuk
mengevaluasi perpanjangan lokal. Laringoskopi langsung dengan biopsi membuat diagnosis.
Pengobatan dan prognosis tergantung pada stadium dan kelas dari limfoma.

Konflik kepentingan
Tidak ada konflik kepentingan.

Referensi
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