Initial manifestation of a diffus large B-Cell-Lymphoma of the paranasal sinuses

Case Report A 76-year-old female patient experiences a fall after months of diplopia and gelatinous rhinorrhoea The patient negated epistaxis, hyposmia and B symptoms.

In the clinical examination the endoscopy reveals a greyish-livid tumor of the right main nasal cavity and choana. The emergency cCT shows an up to 6.1 cm right-emphasized lesion with soft tissue density in the ethmoidal cells on both sides with expansion into the frontal sinus and the sphenoidal sinus on both sides with total displacement and corrosion of the medial wall of the maxillary sinus on the right, the medial orbital wall and the lamina cribrosa with growth in the orbital funnel on the right. Because of a suspected sinunasal carcinoma tissue samples were obtained.

The immunohistochemical examination reveals a highly malignant, LCA- and CD20-positive, diffuse-large B-cell lymphoma (Ki67 proliferation rate 80-90 %). Further staging with CT scans from the neck and thorax also reveals an inhomogeneous spleen, corresponding to a stadium of Ann arbor of IES (IPI score: 4 high risk, Schmitz score: 4 high risk). After presentation in the interdisciplinary lymphoma board cytostatic therapy (R-CHOP) and adjuvant radiotherapy of the NNH bulk were initiated.

Conclusion Lymphomas with initial manifestation in the nasal and paranasal sinuses are extremely rare but should always be included in the differential diagnostic considerations. Imaging procedures as well as histopathological examination in interdisciplinary cooperation are fundamental for a correct diagnosis and early initiation of therapy.

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Publication History

Article published online:
10 June 2020