Nasopharyngeal Lymphoid Hyperplasia: When to Consider a Second Biopsy? - Oncology

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Hello: I asked a question on November 30 last year regarding a right neck swelling and a right nasopharyngeal lymphoid tumor.
The tumor measured 0.6*0.5*0.4 cm, and the biopsy results indicated lymphoid hyperplasia in the nasopharynx with no hidden cancer cells detected.
The doctor informed me that a follow-up visit was not necessary, but I would like to know if I need to have another biopsy.
I am concerned that the condition may not have been accurately diagnosed, as I have recently noticed tightness again in the right neck near the ear and occasional feelings of fullness in the right ear.
The first biopsy was taken from the upper and right portions of the tumor; if I were to have another biopsy, would it be advisable to sample the lower and left portions? I also asked the doctor about the possibility of surgical removal, but the doctor declined.
Is it true that this type of hyperplasia cannot be surgically removed? I feel like there is a heavy burden in my heart that I cannot let go of.
Thank you for your response.

Niming, 20~29 year old female. Ask Date: 2018/03/20

Dr. Lai Yicheng reply Oncology


Hello: Regarding your question, you may visit the ENT outpatient clinic to consult with a physician for an assessment on whether further examination or regular follow-up is necessary.
Thank you for reaching out.
Sincerely, Dr.
Lai Yi-Cheng, Department of Radiation Oncology, Changhua Hospital.

Reply Date: 2018/03/20

More Info


Understanding nasopharyngeal lymphoid hyperplasia (NHLH) can be quite complex, especially when it comes to determining the need for further biopsies or interventions. Based on your previous biopsy results indicating lymphoid hyperplasia without evidence of hidden malignancy, it is understandable that you may have concerns about the possibility of an undiagnosed condition, particularly given your recent symptoms of tightness in the neck and a sensation of fullness in the ear.

Lymphoid hyperplasia in the nasopharynx is characterized by an increase in lymphoid tissue, which can occur as a response to various stimuli, such as infections or chronic inflammation. In many cases, this condition is benign and does not require aggressive treatment. However, the presence of persistent symptoms, such as the tightness in your neck and ear fullness, warrants careful consideration.

When to consider a second biopsy largely depends on several factors:
1. Persistence of Symptoms: If your symptoms have worsened or new symptoms have developed since your last biopsy, this may indicate that further investigation is warranted. The sensation of fullness in the ear, for example, could suggest that there is ongoing inflammation or another underlying issue that needs to be addressed.

2. Physical Examination Findings: If your healthcare provider notes any changes in the physical examination of the lymphoid tissue or surrounding structures, this could also prompt a recommendation for a repeat biopsy.

3. Imaging Studies: If imaging studies (like ultrasound or CT scans) show changes in the size or characteristics of the lymphoid tissue, this could be another reason to consider a second biopsy.

4. Clinical Judgment: Ultimately, the decision to perform a second biopsy should be guided by your healthcare provider's clinical judgment, taking into account your medical history, current symptoms, and the results of any previous investigations.

Regarding your question about the potential for surgical removal of the hyperplastic tissue, it is important to note that lymphoid hyperplasia is typically not removed surgically unless there is a strong suspicion of malignancy or if the tissue is causing significant obstruction or other complications. The nature of lymphoid tissue is such that it can be reactive and may resolve on its own, especially if the underlying cause (like an infection) is addressed.

If your doctor has advised against surgical removal, it is likely because they believe that the risks of surgery may outweigh the potential benefits, especially if the tissue is not causing significant problems. In cases of benign lymphoid hyperplasia, the focus is often on monitoring rather than intervention.

In conclusion, if you are experiencing new or worsening symptoms, it is essential to communicate these concerns with your healthcare provider. They may recommend further evaluation, which could include imaging studies or a repeat biopsy if deemed necessary. It is crucial to have an open dialogue with your doctor about your fears and symptoms, as they can provide the best guidance tailored to your specific situation. Regular follow-ups may also be beneficial to monitor any changes in your condition.

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