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.
Neculcea et al. (Thu,) studied this question.