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Upper aerodigestive tract lymphoma in Taiwan
  1. Shang-Wen Chen1,
  2. Sheng-Tsung Chang2,
  3. Chin-Li Lu3,
  4. Wei-Shou Hwang4,
  5. Chao-Jung Tsao1,
  6. Wen-Tsung Huang1,
  7. Kwang-Yu Chang5,
  8. Shih-Sung Chuang2,6
  1. 1Division of Hemato-Oncology, Department of Internal Medicine, Chi-Mei Medical Centre, Liouying, Tainan, Taiwan
  2. 2Department of Pathology, Chi-Mei Medical Centre, Tainan, Taiwan
  3. 3Department of Medical Research, Chi-Mei Medical Centre, Tainan, Taiwan
  4. 4Division of Hemato-oncology, Department of Internal Medicine, Chi-Mei Medical Centre, Tainan, Taiwan
  5. 5Institute of Cancer Research, National Health Research Institutes, Tainan, Division of Haematology and Oncology, Department of Internal Medicine, National Cheng-Kung University Hospital and College of Medicine, National Cheng-Kung University, Tainan, Taiwan
  6. 6Department of Pathology, Taipei Medical University, Taipei, Taiwan
  1. Correspondence to Dr Shih-Sung Chuang, Department of Pathology, Chi-Mei Medical Centre, 901 Chung-Hwa Road, Yung-Kang City, Tainan, Taiwan 710; cmh5301{at}


Aim To better understand the spectrum of primary lymphomas in the upper aerodigestive tract, a common site of extranodal lymphoma.

Materials and methods Lymphoma cases diagnosed at an institution in southern Taiwan from 1992 to 2007 were retrospectively studied with pathology and history review, immunohistochemistry, in situ hybridisation for Epstein–Barr virus (EBER-ISH), and statistical analysis.

Results 70 patients were identified. The male to female ratio was 2:1, and the median age was 61.5 years (range 8–87); 73% of cases occurred in Waldeyer's ring or the oral cavity. Phenotypically, there were 45 (64%) B cell and 25 (36%) T cell or extranodal natural killer (NK)/T cell lymphoma (ENKL) including 42 (60%) diffuse large B cell lymphomas (DLBCLs), 22 (31%) ENKLs, three unspecified peripheral T cell lymphomas, two follicular lymphomas and one Burkitt lymphoma. EBER-ISH was positive in three (7%) of 42 DLBCLs and all 22 ENKLs. Most patients received chemotherapy with or without radiotherapy. The 5-year overall survival for all patients was 56.3% with B and T or NK/T cell lymphomas at 66.0% and 40.6%, respectively. Univariate analysis revealed that sinonasal presentation, T or NK/T cell phenotype, raised lactate dehydrogenase (LDH) activity, and Ann Arbor stage III/IV diseases were associated with prognostically significant higher hazard ratio (HR) of lymphoma-related death. However, only raised LDH remained significant on multivariate analysis. For DLBCLs, only raised LDH was prognostically significant on either univariate or multivariate analysis.

Conclusions Only a limited number of lymphoma entities occurred primarily in this anatomical region. The 5-year overall survival rate was comparable to other reports, and raised LDH at diagnosis was the only significant prognostic factor identified. A relatively high incidence of EBV positivity was identified in DLBCLs in this anatomical region, and further studies are warranted to elucidate the clinicopathological significance of these tumours.

  • Diffuse large B cell lymphoma
  • EBV
  • extranodal NK/T cell lymphoma
  • lymphoma
  • Taiwan
  • upper aerodigestive tract
  • Waldeyer's ring
  • lymphoma

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  • Funding Chi-Mei Medical Centre and National Science Council, Taiwan.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Chi-Mei Medical Centre, Taiwan.

  • Provenance and peer review Not commissioned; externally peer reviewed.