Multifocal Non-Hodgkin s Lymphoma of the Testis and the Waldeyer s Ring: A Rare Presentation

Case Report

Austin Head Neck Oncol. 2022; 5(1): 1013.

Multifocal Non-Hodgkin’s Lymphoma of the Testis and the Waldeyer’s Ring: A Rare Presentation

Zaffarullah MW and Eliyapura HN*

Department of ENT and Head and Neck Surgeon, District General Hospital Matale, Sri Lanka

*Corresponding author: Eliyapura HN, Department of ENT and Head and Neck Surgery, District General Hospital Matale, 166, MC Road, Matale, 21300, Sri Lanka

Received: January 04, 2022; Accepted: January 31, 2022; Published: February 07, 2022


Waldeyer’s ring non-Hodgkin’s lymphoma (WR-NHL) is uncommon and of that, base of the tongue lymphoma is rare. Similarly testicular NHL too is rare.

We report an unusual case of multifocal base of the tongue and testicular B-cell NHL found simultaneously, which was confirmed by biopsy and immunohistochemistry. This article serves to illustrate the existence of multifocal primaries of NHL in extremely rare extra-nodal sites. Familiarity with such association will help detect multifocal NHL and staging, which has a direct impact on the management.

Keywords: Non-Hodgkin’s lymphoma; Waldeyer’s Ring; Malignant lymphoma; Head and neck; Extranodal; Testicular neoplasm


NHL: Non-Hodgkin’s lymphoma; WR-NHL: Waldeyer’s Ring Non-Hodgkin’s Lymphoma; PTL: Primary Testicular Lymphoma; FDG-PET: Fluorodeoxyglucose-Positron Emission Tomography


About a third of NHL cases occur at extra-nodal sites, but involvement of multiple non-contiguous extra-nodal sites at presentation without lymph node involvement is rare [1]. Moreover, primary testicular lymphoma (PTL) in addition to WR-NHL at presentation has not been reported in the English literature.

Case Presentation

A 62-year-old male presented with dysphagia and hot potato voice for 3 months’ duration. He was admitted for investigation and during his stay complained of a left testicular swelling, which was referred to the Surgical team. The patient has a past medical history significant for chronic obstructive airway disease. He is a regular smoker. The rest of his medical and surgical history was unremarkable.

He denies any weight loss, night sweats or fever. Fibreoptic nasolaryngoscopy examination revealed a large mass in the base of his tongue which appeared quite vascular. Testicular ultrasound scan and Doppler studies were suggestive of a malignant pathology. Tumour size was 55mm. The epididymis and spermatic cord were not involved by the tumour.

Combined direct laryngoscopy and biopsy and left side orchidectomy was done under general anaesthesia by the otolaryngologist and general surgeon respectively. Biopsy sample obtained through direct laryngoscopy of the base of tongue and testicular histology showed features of a high-grade NHL (B-cell type). Tumour cells were positive for CD 20 and negative for CD3, PLAP and AE1/AE3 (Figure 1 and 2).

Citation: Zaffarullah MW and Eliyapura HN. Multifocal Non-Hodgkin’s Lymphoma of the Testis and the Waldeyer’s Ring: A Rare Presentation. Austin Head Neck Oncol. 2022; 5(1): 1013.