case_images: PMC11317266_01
case_images: (A) Flexible laryngoscopy showing slight hypertrophy of the nasopharynx with symmetrical fossa of rosenmuller. (B) A large mass in the base of the tongue, predominantly on the right side. (C) Obvious edema observed in the submucosa of the epiglottis. (D) Edema in the arytenoid complex obstructing the respiratory passage. (E) A reduction in the size of the mass in the base of the tongue following 2 weeks of biopsy. (F) Persistent swelling observed in the epiglottis. (G) Persistent swelling observed in the arytenoid complex. (H) Smooth surface and normal morphology of the vocal cords.
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case_images: PMC11317266_01_fonc-14-1424785-g001.jpg
case_images: f1
case_images: Flexible laryngoscopy demonstrated a slight hypertrophy of the nasopharynx, with symmetrical fossa of rosenmuller ( Figure 1A ). Figure 1B ). Furthermore, there was obvious edema in the submucosa of the epiglottis and arytenoid complex, leading to obstruction of the respiratory passage ( Figures 1C, D ). The results showed that compared to the pretreatment findings, the mass in the base of the tongue had decreased in size ( Figure 1E ). However, there was persistent swelling in the epiglottis and arytenoid complex ( Figures 1F, G ). The surface of the vocal cords appeared smooth and exhibited a normal morphology ( Figure 1H ).
case_images: (A) Computed tomography (CT) imaging revealing nearly normal nasopharynx. Yellow asterisks show the nasopharynx. (B) Irregular, poorly defined boundary soft tissue observed in the oropharyngeal region (yellow dash line). (C) Obvious swelling of the epiglottis (yellow arrowhead). (D) Magnetic resonance imaging (MRI) revealing no significant soft-tissue thickening in the bilateral walls of the oropharynx (red asterisks show the oropharynx). (E) A mass in the base of the tongue (yellow dash line). (F-I) Uniform enhancement in bilateral neck lymph nodes and larger lymph nodes (red arrowhead). R, right; L, left.
case_images: fonc-14-1424785-g002.jpg
case_images: PMC11317266_01_fonc-14-1424785-g002.jpg
case_images: f2
case_images: A preoperative computed tomography (CT) imaging showed an almost normal nasopharynx ( Figure 2A ). There was an irregular, poorly defined boundary soft tissue in the oropharyngeal region ( Figure 2B ). In addition, we also observed an obvious swelling of the epiglottis ( Figure 2C ). Figure 2D ). Furthermore, the imaging showed that in the base of the tongue to the epiglottis region, there was a mass, measuring approximately 36 mm x 31 mm ( Figure 2E ). Bilateral neck lymph nodes and larger lymph nodes were observed and showed uniform enhancement on contrast-enhanced scans ( Figures 2F-I ).
case_images: (A-C) Positron emission tomography and computed tomography (PET-CT) imaging demonstrating thickening of the soft tissues in the left nasopharyngeal region and parapharyngeal space, accompanied by increased metabolic activity. (D) Significant thickening of the soft tissues in tongue base, resulting in narrowing of the pharyngeal cavity (red arrowhead). (E) Enlarged lymph nodes in various regions, exhibiting fusion and increased metabolic activity (red arrowhead).
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case_images: PMC11317266_01_fonc-14-1424785-g003.jpg
case_images: f3
case_images: Positron emission tomography and computed tomography (PET-CT) imaging showed that the left nasopharyngeal region and parapharyngeal space demonstrated thickening of the soft tissues, accompanied by increased metabolic activity ( Figures 3A-C ). Significant thickening of the soft tissues was also observed in the right anterior wall of the oropharynx, tongue base, and epiglottis region, leading to the narrowing of the pharyngeal cavity ( Figure 3D ). Enlarged lymph nodes were detected in various regions, showing fusion and increased metabolic activity ( Figure 3E ).
case_images: H&E staining and immunohistochemistry. (A) H&E staining reveals abundant lymphocytes under the squamous epithelium. (B, C) Immunohistochemical staining showed positivity for CD2 and CD3. (D) Some T lymphocytes are negative for CD7. (E) CD10-positive cells can be found outside the germinal center region. (F) Immunohistochemical staining showed positivity for PD1.
case_images: fonc-14-1424785-g004.jpg
case_images: PMC11317266_01_fonc-14-1424785-g004.jpg
case_images: f4
case_images: ICOS, CXCL13, CD10, BCL6, CD43, CD21 (FDC+), CD30 (scattered+), and TdT ( Figure 4 ) (data shown partially), while it showed negativity for CD7, CD8, MUM1, BCL2, LEF1, cyclin D1, IgD, CD56, and Ki67 (approximately 50% labeling index) (data not shown). In situ hybridization testing for Epstein-Barr virus-encoded RNA (EBER) demonstrated positivity (up to 20/HPF), and T-cell receptor gamma (TCRG) clonality was confirmed by the detection of rearranged bands (R23-00052) in the target region.