Nasopharyngeal Non-Hodgkin’s Lymphoma with a Rare Extra-Nodal Manifestation: A Case Report

Abstract

Aim: This case report highlights a rare instance of a patient who presented with an extra-nodal manifestation of nasopharyngeal non-Hodgkin’s lymphoma at the Redeemers Health Village, a multi-specialty tertiary academic hospital located in the Southwestern region of Nigeria. Presentation of Case: The report details a 51-year-old clergyman diagnosed with a rare extra-nodal nasopharyngeal non-Hodgkin’s lymphoma, classified as Ann Arbor stage II, A, E, X. This diagnosis was confirmed through histological analysis of a core tissue biopsy and a series of contrast-enhanced computed tomography (CECT) scans. The patient was successfully treated with chemotherapy and immunotherapy at the Redeemers Health Village, a multi-specialty tertiary academic hospital. Discussion: Extra-nodal nasopharyngeal lymphoma is rare in the Sub-Saharan Africa region compared to its higher prevalence in Southeast Asia. The definitive method for diagnosis is through histological analysis of tissue biopsies, while imaging studies play a vital role in identifying the location and extent of the disease. Nasopharyngeal lymphoma has some similarities with nasopharyngeal carcinoma in terms of presentation and aetiology. Consequently, distinguishing between these two conditions requires meticulous histological analysis, as well as CT or MRI scans, alongside an examination of their tumorigenesis.  In this index case, the diagnosis of extra-nodal nasopharyngeal non-Hodgkin’s lymphoma was established based on the clinical presentation, tissue morphology, immunohistochemistry, and CT imaging. The patient responded well to chemotherapy and immunotherapy and is currently being followed up in the Haematology clinic, where he is receiving counselling on risks and benefits of radiotherapy as part of further management. Conclusion: The choice of targeted therapy in the management of an extra-nodal nasopharyngeal lymphoma depends on the presence of specific tissue markers, however, chemotherapy, radiotherapy, or a combination of both can be utilised to achieve a successful outcome. In this index case, the patient received a combination of chemotherapy and immunotherapy resulting in remarkable tumor regression and significant improvement in the patient’s overall well-being. To consolidate on these gains, the patient is currently undergoing counselling about the risks and benefits of radiotherapy as part of further treatment plan.