Abstract
Background
Malignant lymphoma of the head and neck represents the most common non-epithelial head and neck cancer. Approximately one third of these occur outside of lymph nodes and have been described in most sub-sites of the head and neck.
Case
We describe a case of an elderly woman who presented with a non-healing ulcer on the posterior aspect of her right pinna. Biopsy was performed and found to be a diffuse large B-cell lymphoma. This patient was treated with chemotherapy and local radiation therapy.
Conclusions
This is the first reported case of an extranodal lymphoma affecting the auricle. We review lymphoma of the head and neck and the role of the otolaryngologist.
1
Introduction
Lymphoma comprises approximately 5%–15% of malignancies of the head and neck. They are the third most common cancer overall and the most common non-epithelial cancer within this region. Extranodal lymphomas represent approximately 30% of these and have been described in most subunits of the head and neck . We describe a patient with a non-healing ulcerative lesion of the right posterior auricle that was found to be a diffuse large B-cell lymphoma, which has not previously been discussed as a site for extranodal lymphoma. The patient was ultimately treated with chemotherapy and radiation. We review lymphoma of the head and neck and the role of the otolaryngologist.
2
Case report
An 83 year-old female was referred to our department with a 2-month history of a non-healing ulcerative lesion with surrounding erythema of the right posterior pinna ( Fig. 1 A and B ), initially noted by her hairdresser. Her primary care physician and an outside otolaryngologist treated the lesion with 3 courses of antibiotics and 1 course of steroids without improvement. The patient reported minimal discomfort, no alteration in hearing but was troubled by the drainage. She reported no previous skin cancers and was adamant that she avoided sun exposure throughout her life due to her fair skin.
A biopsy was performed and a CT of the neck was obtained with cutaneous squamous cell carcinoma leading our differential diagnosis. As such, treatment by partial auriculectomy was preliminarily discussed. The CT scan revealed localized disease to the right auricle as well as artifact from silver nitrate cautery ( Fig. 1 C and D). The biopsy returned as CD20 positive diffuse large B-cell lymphoma, non-germinal center phenotype, with high-grade features including an increased proliferative fraction and Ki-67.
The patient was referred to the Hematology/Oncology department for further management. Bone marrow biopsy was normal; PET/CT scan revealed FDG avid preauricular lymph node that was not apparent on the initial CT of the neck making the final diagnosis T1aN1M0 primary cutaneous B-cell lymphoma. She was started on three R-CHOP cycles followed by localized radiation therapy.
2
Case report
An 83 year-old female was referred to our department with a 2-month history of a non-healing ulcerative lesion with surrounding erythema of the right posterior pinna ( Fig. 1 A and B ), initially noted by her hairdresser. Her primary care physician and an outside otolaryngologist treated the lesion with 3 courses of antibiotics and 1 course of steroids without improvement. The patient reported minimal discomfort, no alteration in hearing but was troubled by the drainage. She reported no previous skin cancers and was adamant that she avoided sun exposure throughout her life due to her fair skin.
