Laskar Siddhartha, Mohindra Pranshu, Gupta Sudeep, Shet Tanuja, Muckaden Mary Ann
Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India.
Leuk Lymphoma. 2008 Dec;49(12):2263-71. doi: 10.1080/10428190802493686.
Extranodal non-Hodgkin lymphoma (NHL) in head and neck region is most commonly seen in the Waldeyer's ring. Waldeyer's ring is a unique subtype of mucosa associated lymphoid tissue (MALT), which shows rarity of low-grade or MALT-type lymphomas and a high incidence of diffuse large B cell lymphoma (DLBCL). The commonest histology is DLBCL with natural history similar to primary nodal NHL. However, high association with gastrointestinal involvement is reported. The diagnostic workup is similar to that of the usual nodal NHL, and in absence of a specific staging system, the Ann Arbor staging is followed. As compared with T-cell subtypes, B-cell phenotypes are less likely to present with mucosal ulceration, epitheliotropism and angioinvasion. Stage of disease, histology and use of combined modality treatment have been proposed as significant prognostic factors. Treatment has evolved from the use of extended field radiotherapy (RT) alone to the use of combined chemotherapy and RT leading to almost doubling of survival. Advances in pathology and further risk stratification of patients into prognostic groups could lead to the development of novel therapeutic strategies to improve outcome.
头颈部结外非霍奇金淋巴瘤（NHL）最常见于瓦尔代尔环。瓦尔代尔环是黏膜相关淋巴组织（MALT）的一种独特亚型，其中低度或MALT型淋巴瘤少见，弥漫性大B细胞淋巴瘤（DLBCL）发病率高。最常见的组织学类型是DLBCL，其自然病史与原发性结内NHL相似。然而，有报道称其与胃肠道受累高度相关。诊断检查与一般结内NHL相似，在没有特定分期系统的情况下，采用安阿伯分期。与T细胞亚型相比，B细胞表型较少出现黏膜溃疡、亲上皮性和血管浸润。疾病分期、组织学类型以及综合治疗的应用已被认为是重要的预后因素。治疗方法已从单纯使用扩大野放疗（RT）发展为联合化疗和RT，使生存率几乎提高了一倍。病理学的进展以及将患者进一步进行风险分层纳入预后组可能会促使开发新的治疗策略以改善治疗效果。
