Images in Clinical Medicine

Pharyngeal Mass in a Patient with B-Cell Lymphoma

Chung-Ching Hung, M.D., and Jih-Chin Lee, M.D.

N Engl J Med 2009; 360:2340May 28, 2009

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Article

An 84-year-old man presented with an isolated sensation of a lump in the back of his throat and difficulty swallowing that had developed over several months. A year earlier, the patient had received a diagnosis of lymphoma involving the inguinal lymph nodes, which had been treated with CHOP combination therapy (cyclophosphamide, doxorubicin, vincristine, and prednisone). This therapy resulted in a partial remission of the lymphoma. The physical examination revealed a mass in the posterior oropharynx. Cervical and inguinal lymphadenopathy were present; there was no hepatosplenomegaly, and the peripheral-blood smear was normal. Endoscopy revealed a large pharyngeal mass on the right side (Panel A). Computed tomography showed a mass, 4 cm by 3 cm, occupying the right oropharynx (Panel B). The mass was excised, and pathological analysis confirmed a B-cell lymphoma. The patient was treated with two cycles of CHOP and has had stable, nonprogressive disease and no throat symptoms at recent follow-up visits.

Chung-Ching Hung, M.D.
Jih-Chin Lee, M.D.
Tri-Service General Hospital, Taipei 114, Taiwan