Waldeyer’s ring Function, Infection, Cancer, Lymphoma

Waldeyer's ring Function, Infection, Cancer, Lymphoma

Waldeyer’s ring is characterized by several tonsillar structures including; pharyngeal tonsil, tubal tonsils, palatine tonsils and lingual tonsils which are collectively aligned in a ring in the naso-oropharyngeal cavity. Additionally, these tonsillar bodies are interconnected with the lymphoid tissues known as mucosal-associated lymphoid tissues (MALT) which spreads approximately to the whole lining of the nasopharyngeal cavity (from the upper portion of the soft palate to the back of the oral cavity).

All these structures making up the Waldeyer’s ring show the highest structural as well as functional similarities. That’s why their response to any unexpected abnormity has been seen to the same resulting in the airway blockage which acquires the same management and treatment.

Initially, Waldeyer’s ring was discovered in 1884 by a Germananatomist namedHeinrich Wilhelm Gottfried von Waldeyer-Hartz.

Waldeyer’s ring  Function

The basic tonsillar structures of the waldeyer’s ring including adenoids, tubal tonsil, palantine tonsil, and lingual tonsil are considered as the manufacturing units of the antibodies to fight against the common pathogens present in the environment. The ring also contains a good amount of mucosa-associated lymphoid tissues which is present in-between the tonsillar structures leading to an approximate coverage of the whole lining of the oropharynx and nasopharynx. These tissues are abundant with the T cells, B cells as well as macrophages which present this whole structure as a fighting equipment against the adaptive infections of this area of the oral cavity.

Because of this quality and specified location, waldeyer’s ring is considered as a first-line defensive mechanism of the human body against microbes. As the first encounter of the pathogen occurs at this point in the body including nasal and oral route, so if it is encountered well, it can lead to the prevention of complex infectious diseases.

Waldeyer's ring Function, Infection, Cancer, Lymphoma

Waldeyer’s ring Infection

The tonsillar structures of the ring are divided into two compartments depending upon their physiological activities. The first one is known as epithelial compartment which consists of only the outer parts of the ring and responsible for the uptake of the pathogens entering the human body through nasal or oral route. Meanwhile, the second compartment is the lymphatic compartment which comprises the fundamental manufacturing units of the antibodies and responsible to produce antibodies in response to the externalrecurrent stimuli.

Any abnormality in these structural units of the ring will lead to the adaptive modifications in the epithelial compartment resulting in the loss of uptake of the pathogens ultimately leading to the impairment of the immunological activity of this specified system. These abnormalities involve the overproduction of the cytokines as a result of recurrent stimuli leading to the continuous activation and multiplication of fibroblasts and endothelial cells. This abnormal activation may lead to the extensive replacement of the immunologically active units with immunologically dead units involving fibrotic tissues.

Waldeyer’s ring Cancer

Tonsils and nasopharyngeal cavity and the tongue in the human body are considered to be highly vulnerable for the formation of cancer. The specified abnormalities in the structural units of the waldeyer’s ring may result in the excessive production of immunologically dead tissues which continuously repeat the active ones and lead to the formation of tumors.

This may result in the presentation of some clinical symptoms including otalgia (pain in the ear), pain in the throat, sore throat or airway blockage. However, in many cases, severe ulceration has been seen associated with the formation of an enlarged submucosal mass.Usually, these are unilateral only involving the one adenoid or tonsil.

However, detailed pathological history and diagnosis is required to distinguish the carcinomas from the highly spreading malignant lymphomas.

Waldeyer’s ring Lymphoma        

Weldeyer’s ring lymphomas are very common and involve a different kinds of lymphomas. These may include;

Extranodal non-Hodgkin’s lymphomas:This ring is designated as an extranodal site rather than the extra lymphatic site and yet highly vulnerable to the formation of extranodal non-Hodgkin’s lymphomas. Almost 50% of the whole extranodal non-Hodgkin’s lymphomas exist in the waldeyer’s ring which mainly affects the male population more than the female population. These are rare due to the extranodal involvement of the waldeyer’s ring.

Mantle cell lymphoma: Another most common lymphoma of this ring is known as B-cell lymphoma commonly known as mantle cell lymphoma. It can develop at any period of the age but the most vulnerable era is considered to be the late 50-70s. It resembles with the lymphomas of other sites, structurally and somehow functionally too. The underlying cause is mainly genetic which involves the mutations in the genes of chromosomes 11 and 14. It usually shows a reduced prognosis that leads to the low survival rate of approximately 3-4 years. Meanwhile, in some patients, the course is experienced to be lethargic resulting in a better survival rate.

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