Non-Hodgkin's lymphoma affecting the Waldayer's ring: the need for appropriate referral and multidisciplinary management

Abstract

Background:  Non-Hodgkin's lymphoma (NHL) is a tumour which commonly affects the head and neck. Extranodal NHLs of the head and neck usually arise within Waldayer's ring. In most cases the diagnosis is missed and this poses a challenge to both the clinicians and patients.
Aim: Firstly, to promote robust referral patterns between clinicians and secondly, to put emphasis on the importance of reviewing and reacting to the outcome of investigations promptly to avoid unfavourable events in patient management.
Case report:  Three cases of NHL involving the Waldayer's ring are reported. Their serological testing for HIV, HBV and HCV were all negative. Two of them had tonsillectomy in peripheral centres to relieve symptoms of dysphagia. The management of the patients was affected because the initial diagnoses made were wrong.
Conclusion: There should be an open communication between clinicians either within same hospital or other hospitals. Above all, prompt referrals should be encouraged to prevent an increase in the morbidity and mortality of patients.

Keywords: Non-Hodgkin's lymphoma, Waldayer's ring, Multidisciplinary management, Appropriate referral