Woman of white race, 80 years old, without personal history of interest, who came to our consultation for presenting progressive dysphagia of one month of evolution.
The examination revealed an erythematous, partially ulcerated induration on the dorsum of the tongue, which was painful to the touch.
The presence of adenomegaly or other cervical masses was not observed.
An incisional biopsy was performed and the histopathological study showed the existence of a uniform proliferation of lymphoid cells compatible with lymphoma.
Preoperative laboratory tests showed no significant abnormalities.
Under local anesthesia, the tumor was removed with wide safety margins.
Microscopically, the lymphoid infiltrate ulcerated the epithelial surface surrounding the lingual musculature.
Around this infiltrate, multiple lymphoid cells could be recognized; some showed germinal centers homogeneous eosinophilic substance centres with stromal germinal histiocytes (starry-sky); others showed regressive changes in the depositions
All were surrounded by an important perifollicular infiltrate composed of small lymphoid cells with slightly irregular nuclei and moderately dense chromatin accumulations similar to the centrocytes of the marginal zone.
It was also possible to recognize the existence of numerous histiocytes and eosinophils.
Occasionally, some large cells, with a prominent feature, intermingled with small columnar cells of centroblasts and immunoblasts.
It was also possible to recognize the existence of an important differentiation in the paraseptal and subepithelial areas.
On the edges of the tumor, the existence of partially preserved lobes of minor salivary glands was observed, showing a prominent mucoid infiltrative type.
The salivary ducts were dilated and infiltrated by B cells with occasional formation of epimyoepithelial islands.
It was also possible to recognize abundant plasma cells around the glandular ducts.
Immunohistochemical study was performed on frozen sections fixed in formalin and paraffin, using the streptoavidin-biotin method.
The following antibodies were used: CD20, CD3, CD5, CD10, CD23, CD43, DBA44, CD68, immunoglobulins α, γ, μ of heavy chain and κ, λ of light chain.
The centrocytic cells showed a phenotype B, with positivity for CD20, CD5 and CD43.
CD10, CD23 and DBA44 were negative.
The presence of a small proportion of T cells was also evidenced, with positivity for CD3.
Plasma cells in the paraseptal and subepithelial bands as well as in the canals of the mucous glands showed production of immunoglobulin IgG/κ.
The definitive diagnosis was MALT lymphoma.
Morphological alterations of minor salivary glands close to the tumor were interpreted as myoepithelial sialadenitis.
The patient had no other manifestations of the disease, such as Sjögren's syndrome, disseminated rheumatoid arthritis, lupus erythematosus, or myeloma thyroiditis.
Lymphoma was therefore considered to be stage IE.
The patient has not received any treatment except surgery, without presenting signs of disease one year after diagnosis.
