Anticonvulsant‐induced lymphoma

AbstractPatients with cervical adenopathy of obscure etiology may present a diagnostic problem to the otolaryngologist. The hydantoin family of anticonvulsants is a rare cause of adenopathy that may range from histologically simple lymphoid hyperplasia to true lymphoma. Between these two extremes is a benign clinical entity with the histologic characteristics of lymphoma.A patient on diphenylhydantoin (Dilantin) therapy developed bilateral true vocal cord paralysis and cervical adenopathy. On pathological examination the lesion was interpreted first as malignant lymphoma and later as hydantoin‐induced pseudolymphoma. He has now been followed for over two years.Hydantoin‐induced adenopathy may vary clinically from a benign condition to a true lymphoma. The malignant form may present long after the anticonvulsant treatment is discontinued. A 10‐fold increase in the expected incidence of malignant lymphoma in epileptic patients on hydantoin therapy has been reported; therefore, these patients required long‐term follow‐up.The otolaryngologist should be aware of this rare clinical entity as an unusual cause of cervical adenopathy associated with vocal cord paralysis.