Kosin Med J.  2019 Jun;34(1):78-82. 10.7180/kmj.2019.34.1.78.

A Case of Malignant Lymphoma Misdiagnosed as Acute Tonsillitis with Subsequent Lymphadenitis

• Kim YC
• Kwon M
• Kim JP
• Park JJ

• KMID: 2451780
• DOI: http://doi.org/10.7180/kmj.2019.34.1.78

Abstract

A 56-year-old female presented with clinical features of acute tonsillitis with subsequent cervical lymphadenitis. After taking empirical antibiotics for 1 week, the acute infection symptoms and signs were resolved. However, an asymmetric enlargement of the left palatine tonsil with ipsilateral neck swelling remained. Subsequent tonsillectomy and lymph node excisional biopsy were performed due to the possibility of malignancy. The patient was eventually diagnosed as malignant lymphoma according to pathological confirmation. We demonstrate the diagnostic challenges in such a rare case and emphasize the importance of differentiating malignant lymphoma from an atypically presenting acute infectious disease.

Keyword

Lymphadenitis; Lymphoma; Tonsillitis

MeSH Terms

Anti-Bacterial Agents
Biopsy
Communicable Diseases
Female
Humans
Lymph Node Excision
Lymphadenitis*
Lymphoma*
Middle Aged
Neck
Palatine Tonsil*
Tonsillectomy
Tonsillitis*
Anti-Bacterial Agents

Figure

• 

  Fig. 1 Endoscopic examination of the tonsil. (A) Enlarged right palatine tonsil, (B) Asymmetrically enlarged left palatine tonsil with exudate on its surface.

• 

  Fig. 2 Contrast enhanced computed tomography scan of the patient. (A) Hypertrophic and slightly enhanced left palatine tonsil (white arrow) and (B) Enlarged ipsilateral cervical lymph node which showed central low attenuated lesion (hollow arrow).

• 

  Fig. 3 Histopathological findings and immunohistochemical staining of the lymph node. (A) Diffusely infiltrated atypical lymphoid cells (H&E stain, ×400), (B) Strongly positive for CD20 immunohistochemical staining (×400).

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