Abstract
The paranasal sinuses are rare sites for origination of primary Non-Hodgkin’s lymphoma (NHL). Most often, primary paranasal lymphomas are diffuse large B-cell lymphomas (DLBCL) associated with a poor prognosis. This paper describes an uncommon case of ethmoid sinus lymphoma with lateral displacement of the left orbit and involvement of the nasal vault, skull base, and frontal sinuses. Excisional biopsy and flow cytometry findings favored the diagnosis of DLBCL, non-germinal center type. Moreover, CT showed an epigastric mass and enlarged lymph nodes along the left iliac chain and spleen. Radiation therapy was immediately started and the patient achieved significant symptomatic relief after four treatments. Accurate diagnosis of extranodal NHL lymphomas through a thorough history, physical exam, imaging, and immunopathology is necessary to initiate prompt treatment of this rare, aggressive disease.
Highlights
IntroductionPrimary sinonasal lymphomas are rare manifestations of extranodal Non-Hodgkin lymphomas (NHL) and constitute only 2% of all primary extranodal NHL [1]
The subsequent delay in treatment may affect prognosis, timely diagnosis and initiation of therapy are of utmost importance
In this report we describe an unusual case of primary paranasal diffuse large B-cell lymphoma (DLBCL) with local invasion to surrounding tissues
Summary
Primary sinonasal lymphomas are rare manifestations of extranodal Non-Hodgkin lymphomas (NHL) and constitute only 2% of all primary extranodal NHL [1]. Diffuse large B-cell lymphoma (DLBCL) is the most prevalent subtype of NHL in the paranasal sinuses and is associated with poor prognosis [2]. A 52-year-old male was initially evaluated for gradual enlargement of a left face mass of one-year duration. He presented to the emergency department with complaints of pain and swelling of left side of his face, eventually the mass covered his left face and forced his left eye closed. Flow cytometry revealed CD20 positive CD10 negative cells and BCL-2 was positive with variable BCL-6 positivity (Figure 4). These findings were consistent with malignant Non-Hodgkin’s large B cell lymphoma, non-germinal center type. The patient was subsequently evaluated by medical oncology for systemic chemotherapy with R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, Prednisone)
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