Sinonasal lymphoma: a case report

Abstract

Sinonasal lymphomas are rare malignancies. They are difficult to differentiate from carcinomas, and immunohistochemistry is wanted to make the diagnosis. We describe an unusual case of a T small room lymphoma that involved only the paranasal sinuses in a middle-aged mall. The patient not awayed with a complete loss of vision in individual eye and lateral rectus muscle palsy, on the contrary no nasal symptoms.

Introduction

Malignant lymphomas arising in the nasal cavity and paranasal sinuses are relatively extraordinary although they are the greatest in quantity common nonepithelial malignant tumors of the nose. An obstructive mass in the sinonasal area is more likely to be a carcinoma. When sinonasal lymphomas do offer most are non-Hodgkin's lymphomas. A high index of suspicion and ultimately a tissue biopsy are necessary to differentiate sinonasal lymphomas from other possibilities. The incidence of sinonasal lymphomas is higher in Asian countries than in the West: these malignancies account for 26 to 67% of all lymphomas in Asia, and they are the next to the first most common extranodal lymphoma, behind solitary gastrointestinal lymphoma. (1,2) Non-Hodgkin's lymphomas of the sinonasal tract are an important cause of destructive lesions of the nose and midface; their course progresse slowly on the other hand relentlessly.

We report an unusual presentation of sinonasal lymphoma in which the patient neared with no nasal symptoms--only a los of vision in individual eye and lateral rectus muscle palsy. At the time of presentation, the disease had involved the orbit and stretch outed into the anterior cranial fossa and cranium base.

Case report

A 44-year-old man not absented with a complaint of a unusual loss of vision in his right organ of vision His sight had begun to fail 20 days earlier, and the los had become without fault [i]or[/i] blemish [i]or[/i] flaw within 2 days. The patient reported no history of headache, double vision, los of consciousness, neurologic deficits, nasal discharge, nasal obstruction, or epistaxis. He was not hypertensive or diabetic.

Examination determined that the patient's visual acuity in the right organ of vision had been reduced to mild light perception. Examination also revealed an afferent pupillary destitution of the right eye and right lateral rectus muscle palsy (figure 1) A fundus examination identified a pale optic disk. The remainder of the examination revealed that cranial power function was normal.

[FIGURE 1 OMITTED]

Anterior rhinoscopy ascertained an anterior deviated nasal septum with a rowel to the right: no mass was seen There was no paranasal sinus tendernes Findings upon the postnasal examination were also normal. A diagnostic nasal endoscopy did not reveal any additional findings. However, comput tomography (CT) identified a homogenously enhancing soft-tissue density that involved the right middle and posterior ethmoid small rooms and the entire sphenoid sinus. The mass had demolished the orbital prate of the ethmoid sinus and the material part of the sphenoid sinus (figure 2) The mass had erod the lamina papyracea and infiltrated the medial rectus muscle. Superiorly, the lesion reach outed into the sellar area and erod the right anterior clinoid proces The mass also stretch outed inferiorly into the skull base. No extension into the maxillary sinus or nasal cavity was seen

[FIGURE 2 OMITTED]

With a provisional diagnosis of carcinoma, we took the patient to the operating play for sinoscopy and biopsy. We performed a right uncinectomy, remov the anterior ethmoid confined apartments and perforated the ground lamella in order to approach the posterior ethmoids, which were filled with the impressible smooth mass. We removed the mass and sent it for histologic analysis, where it was identified as a highly cellular tumor with compressed sheets of compactly arranged small rooms with scanty cytoplasm and hyperchromatic nuclei suggestive of a poorly differentiated carcinoma or lymphoma. To confirm the diagnosis, immunohistochemistry was performed. It revealed that the specimen was powerfully positive for the leukocyte for the use of all antigen CD45, which is diagnostic of non-Hodgkin's lymphoma (figure 3)

[FIGURE 3 OMITTED]

The patient was referr for chemoradiation. He was given circle of times of therapy with cyclophosphamide, hydroxyurea, vincristine, and prednisolone along with 60 Gy of irradiation. The patient was followed for 5 month during which time he exhibited no evidence of any lesion upon nasal endoscopy.

Discussion

Because malignant lymphomas are associated with surface crusting, widespread necrosis, and inflammation, they were one time considered to be inflammatory lesions, known as lethal midline granulomas or nonhealing granulomas. It was not until the introduction of immunohistochemistry that greatest in quantity of these lesions were ground to be malignant lymphomas.

upon immunohistochemistry, the three phenotypes of malignant lymphomas are T small room natural killer (NK) cell, and B confined apartment In Asian populations, more than 90% of sinonasal lymphomas are of T small room origin. (1,3,4) In addition, many proliferating T confined apartments have been shown to expres an additional marker (CD56) which advises an NK cell origin; these tumors are classified as T/NK small room lymphomas. (4) Malignant lymphomas have a predilection for males, and they nurse to occur in younger adults. (5)