Bulky diffuse large B-cell lymphoma of the naso-oro-hypopharynx in an elderly patient presenting with airway obstruction

Diffuse large B-cell lymphoma (DLBCL) of the naso-oro-hy­po­pha­rynx is a rare site of presentation, and it can pre­sent as bulky, obstructive disease. We report the case of a 67-year-old woman presenting with a massive ul­ce­ro-vegetative tumor causing near-complete airway ob­struc­tion, requiring tracheostomy and gastrostomy. Biopsy confirmed the diagnosis of DLBCL, NOS, non-ger­mi­nal center B-cell subtype, with Ki-67 of approximately 80%. Imaging revealed a bulky tumor (97×91×131 mm) en­ca­sing bilateral jugular-carotid vessels with right in­ter­nal ju­gu­lar vein thrombosis and limited cervical lym­pha­de­no­pathy; gastric involvement was suspected, but bone mar­row was uninvolved. Emergency chemotherapy was ini­tia­ted, and tumor reduction (approximately 50%) was achieved after two cycles of treatment. The patient re­ceived local radiotherapy (45 Gy/25 fractions) and R-CHOP chemotherapy until six cycles. Multiple infectious com­pli­ca­tions occurred, but they were successfully managed. PET-CT after therapy confirmed the complete metabolic res­ponse, maintained on long-term follow-up. At 4.5 years after the diagnosis, the patient is fully independent, with a good quality of life. This case illustrates that even extensive naso-oro-hypopharyngeal diffuse large B-cell lymphoma in elderly patients can achieve durable remission through in­di­vi­dua­lized multidisciplinary management.