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CASE REPORT
A sinister mixed phenotype acute leukemia mimicking tonsil lymphoma
1
Department of Otorhinolaryngology-Head Neck Surgery, School of Medical Sciences Universiti Sains Malaysia Health Campus, Malaysia
2
Department of Otorhinolaryngology, Hospital Raja Perempuan Zainab II, Kelantan, Malaysia
3
Department of Hematology and Transfusion Medicine Unit, School of Medical Sciences Universiti Sains Malaysia Health Campus, Malaysia
4
Hospital Universiti Sains Malaysia, Health Campus, Kota Bharu, Kelantan, Malaysia
5
Department of Pathology, School of Medical Sciences Universiti Sains Malaysia Health Campus, Malaysia
Submission date: 2022-02-06
Final revision date: 2022-03-14
Acceptance date: 2022-03-15
Online publication date: 2022-04-04
Corresponding author
Norhafiza Mat Lazim
Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Health Campus 16150 Kubang Kerian, Kelantan, Malaysia. Tel.: +60199442664.
Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Health Campus 16150 Kubang Kerian, Kelantan, Malaysia. Tel.: +60199442664.
Pol. Ann. Med. 2023;30(1):58-62
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Unilateral tonsillar hypertrophy with accompanying cervical lymphadenopathy gives immediate suspicion of lymphoma or squamous cell carcinoma as the most probable diagnosis.
Aim:
We aim to highlight the role of diagnostic tonsillectomy for intact looking tonsil as opposed to incisional biopsy for obvious fungating mass or ulcerative lesion. We also emphasise not to overlook abnormal preliminary blood work up. If leukocytosis is present, a peripheral blood film must be done to rule out ongoing infection or a more cynical haematological disease.
Case study:
We report a case of a young female presenting with progressive dysphagia as well as bilateral neck swelling. Examination showed a unilateral tonsillar hypertrophy with bilateral cervical lymph nodes highly suggestive of tonsil lymphoma.
Results and discussion:
She was opted for tonsillectomy for both diagnostic as well as therapeutic purposes. Histopathological examination (HPE) of the left tonsil removed paired with an elaborated blood workup finally diagnosed her with a rare case of mixed phenotype acute leukemia.
Conclusions:
A multidisciplinary team approach and early intervention are crucial to arrive at the correct diagnosis allowing prompt treatment and better prognosis and symptomatic relief.
Unilateral tonsillar hypertrophy with accompanying cervical lymphadenopathy gives immediate suspicion of lymphoma or squamous cell carcinoma as the most probable diagnosis.
Aim:
We aim to highlight the role of diagnostic tonsillectomy for intact looking tonsil as opposed to incisional biopsy for obvious fungating mass or ulcerative lesion. We also emphasise not to overlook abnormal preliminary blood work up. If leukocytosis is present, a peripheral blood film must be done to rule out ongoing infection or a more cynical haematological disease.
Case study:
We report a case of a young female presenting with progressive dysphagia as well as bilateral neck swelling. Examination showed a unilateral tonsillar hypertrophy with bilateral cervical lymph nodes highly suggestive of tonsil lymphoma.
Results and discussion:
She was opted for tonsillectomy for both diagnostic as well as therapeutic purposes. Histopathological examination (HPE) of the left tonsil removed paired with an elaborated blood workup finally diagnosed her with a rare case of mixed phenotype acute leukemia.
Conclusions:
A multidisciplinary team approach and early intervention are crucial to arrive at the correct diagnosis allowing prompt treatment and better prognosis and symptomatic relief.
ACKNOWLEDGEMENTS
A special thanks to all the co-authors from the pathology and hematology for their contributions and to those who were actively involved in diagnosing this unique case. An extended warm gratitude for the hemato-oncologists as well for their prompt decisions in commencing the appropriate treatment for the patient.
FUNDING
None declared.
CONFLICT OF INTEREST
None declared.
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