Mantle Cell Lymphoma of the Base of the Tongue

Lymphomas represent the second most common malignancy of the head and neck, with Waldeyer’s ring being the predominant extranodal site. Mantle cell lymphoma (MCL) is an uncommon subtype of non-Hodgkin lymphoma and rarely presents in the lingual tonsil. Only a few such cases have been reported in the literature. We report the case of a 77-year-old woman who presented with a 3-week history of dysphagia and ipsilateral aural fullness. Clinical examination was largely unremarkable except for a multinodular thyroid gland. Fiberoptic laryngoscopy and subsequent CT imaging revealed a 3.8 cm exophytic mass arising from the lingual tonsil, accompanied by bilateral cervical lymphadenopathies. Surgical excision of the lesion yielded a diagnosis of MCL based on immunohistochemical analysis. Staging investigations demonstrated no bone marrow involvement but multiple hypermetabolic cervical lymph nodes; the disease was classified as stage IIA. The patient received 8 cycles of R-CHOP chemoimmunotherapy followed by rituximab maintenance therapy. Post-treatment PET imaging showed complete remission, and the patient remains disease-free 3 years after completion of R-CHOP. Mantle cell lymphoma of the lingual tonsil is exceedingly rare, with only 4 previously reported cases. This case underscores the importance of considering lymphoma in the differential diagnosis of base-of-tongue masses and highlights that multimodal management with chemoimmunotherapy can achieve favorable outcomes, even in elderly patients with limited-stage disease.