Tinsae Anebo, MD1, Karecia Byfield, MBBS2, Laith Alomari, MD3, Hamza Tahir, MBBS, MD2, Adrian Zhou, MD4, Michael L. Davis, DO5 1Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; 2Jefferson Einstein Hospital, Philadelphia, PA; 3Thomas Jefferson University, Philadelphia, PA; 4Albert Einstein Medical Center, Philadelphia, PA; 5Jefferson Health, Philadelphia, PA 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 female with a history of hypertension and osteoarthritis presented with a rapidly enlarging tongue base lesion over one 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.CT 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 CT 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 (FISH) 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 (PEG) tube were placed. Systemic chemotherapy was initiated with the Rituximab-mini-CHOP regimen.After three 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.
Figure: Image 1- A significant, exophytic, smooth, broad-based, non-ulcerated mass was observed at the right base of the tongue.
Figure: A. Axial CTA at the level of the submandibular gland (s). B. Sagittal CTA at midline. Note the presence of the tracheostomy tube. Computed Tomography Angiography (CTA) of the neck demonstrates a large heterogenous enhancing mass-4.5 x 2.3 x 4.4 cm (orange arrow) centered at the base of the tongue (t), which completely effaces the oropharyngeal airway. Bilateral cervical lymphadenopathy is present, the largest of which is a right level 2 lymph node-1.5 x 2.0 x 2.2 cm (blue arrow).
Disclosures: Tinsae Anebo indicated no relevant financial relationships. Karecia Byfield indicated no relevant financial relationships. Laith Alomari indicated no relevant financial relationships. Hamza Tahir indicated no relevant financial relationships. Adrian Zhou indicated no relevant financial relationships. Michael Davis indicated no relevant financial relationships.
Tinsae Anebo, MD1, Karecia Byfield, MBBS2, Laith Alomari, MD3, Hamza Tahir, MBBS, MD2, Adrian Zhou, MD4, Michael L. Davis, DO5. P2827 - An Extremely Rare Presentation of Lymphoma Causing Mechanical Oropharyngeal Dysphagia: A Case Report, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
