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Rémi Marianowski, MD; Michel Wassef, MD; Laurent Amanou, MD; Philippe Herman, MD, PhD; Patrice Tran-Ba-Huy, MD

Arch Otolaryngol Head Neck Surg. 1998;124:1037-1040.

Background  T lymphocytes expressing the T-cell receptor represent a minority of normal T lymphocytes and are mostly located in the spleen or mucosa. Lymphomas expressing the T-cell receptor are rare and usually present as hepatosplenic (negative for Epstein-Barr virus) disease. Primary lymphomas of the larynx are also rare.

Objective  To report the first case of primary laryngeal T-cell lymphoma related to Epstein-Barr virus infection.

Design  Single-case study, including clinical, histological, immunohistochemical, and ultrastructural analysis, and in situ hybridization for Epstein-Barr virus–encoded small nuclear RNA.

Patient  An 88-year-old man presenting with a 6-month history of a cough followed by progressive dysphonia and a thickening of the left aspect of the aryepiglottic fold.

Intervention  Two weeks of treatment with corticosteroids and antibiotics, followed by radiotherapy and then chemotherapy with chlorambucil and corticosteroids.

Outcome  The patient died of heart failure 10 months after the onset of the disease.

Results  The tumor was laryngeal and disseminated to the skin over the parotid gland. Tumor cells were medium-sized T cells of cytotoxic immunophenotype, expressed the T-cell receptor, and contained azurophilic granules and cytotoxiclike granules detected on electron microscopy. Epstein-Barr virus–encoded small nuclear RNA was detected in most tumor cells.

Conclusions  Lymphomas with a T-cell cytotoxic phenotype expressing the T-cell receptor are rare, and this case appears to be the first to involve the larynx. The association between Epstein-Barr virus and T-cell lymphomas has been shown to be frequent in the upper respiratory tract and is confirmed in this case. This finding suggests that T cells in the upper respiratory tract may be more exposed to Epstein-Barr virus infections, perhaps because of their anatomical location.

From the Departments of Oto-Rhino-Laryngology and Head and Neck Surgery (Drs Marianowski, Amanou, Herman, and Tran-Ba-Huy) and Pathology (Dr Wassef), Hôpital Lariboisière, Paris, France.

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