Abstract
Snoring is a common complaint in the primary care and otolaryngology clinic with a wide differential diagnosis. Primary nasopharyngeal mantle cell lymphoma is a rare cause of a nasopharyngeal mass, which can commonly manifest as snoring. The patient in this case presented with extensive history of recent worsening snoring as well as nasal congestion over the past several months. Additionally, the patient had previously undergone endoscopic sinus surgery several years prior but was lost to follow up. During nasal endoscopy, a nasopharyngeal mass was visualized with near-complete obstruction of the nasal airway. Intraoperative biopsies indicated MCL which is an uncommon pathology presenting in a rare location. Flow cytometry of the biopsy specimen was CD19+, CD20+, CD5+, and positive for lambda light chains with immunohistochemistry showed strong diffuse cyclin D1 nuclear staining on lymphoid cells. PET/CT and bone marrow biopsy were essential in staging disease, predicting success of treatment, and determining optimal treatment planning. Once the diagnosis was established, R-CHOP therapy alternating with R-DHAP for a total of six cycles. This case report highlights the importance of recognizing new or changing symptoms, appropriate diagnostic workup for lymphoma, as well as one of few case reports describing primary nasopharyngeal mantle cell lymphoma.
Highlights
Lymphomas are separated into Hodgkin Lymphoma (HL) and Non-Hodgkin Lymphoma (NHL), with NHL being responsible for the majority of cases.[2]
Mantle cell lymphoma (MCL) is a NHL accounting for approximately 6% of all NHL
It was suggested that aerodigestive tract tumors (ADTT), such as primary nasopharyngeal MCL, should be considered in patients with Obstructive Sleep Apnea Syndrome (OSAS) and sudden worsening of symptoms such as gasping or snoring exacerbation.[12]
Summary
Head and neck lymphomas account for 12-15% of all lymphomas and most commonly present as a painless neck mass.[1,2] Lymphomas are separated into Hodgkin Lymphoma (HL) and Non-Hodgkin Lymphoma (NHL), with NHL being responsible for the majority of cases.[2]. To the authors’ knowledge, there have only been two incidences of primary nasopharyngeal MCL described in the literature with this case report being the third.[7,8] There are several retrospective reviews which separate various types of head and neck lymphomas by location. CASE REPORT: The patient was a Caucasian male in his mid-sixties who presented to the authors’ community otolaryngology clinic with chief complaint of nasal congestion over three months He admitted to louder snoring recently, with mild clear bilateral rhinorrhea. Several months prior to presentation, he had failed to obtain relief from multiple oral antihistamines, fluticasone, and oxymetazoline He denied recent imaging or post-surgical follow-up. He admitted to possible sinus infections without improvement after multiple rounds of antibiotics and oral steroid therapy. A positive bone marrow biopsy was performed followed by treatment with chemotherapy using R-CHOP therapy alternating with R-DHAP for a total of six cycles
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