Diffuse large B-cell lymphoma in the sphenoid sinus: A case report and review of literature

Abstract

Background: Non-Hodgkin lymphomas (NHLs) in paranasal sinus are uncommon, accounting for 0.17–2% of all NHL cases; it is especially rare in the sphenoid sinus. In this report, we describe a case of NHL in the sphenoid sinus. Case Description: A 66-year-old man presented with a sudden left eye movement disorder. His head computed tomography and gadolinium-enhanced magnetic resonance imaging (Gd-MRI) showed a mass lesion extending around the left sphenoid sinus. However, the tumor regrowth about twice was observed during 2 weeks, partial removal of tumor was performed by the endoscopic trans-nasal transsphenoidal surgery, then histologically proved it to be diffuse large B-cell lymphoma (DLBCL). After R-THP-COP regimen (rituximab 375 mg/m2, cyclophosphamide 750 mg/m2, epirubicin 50 mg/m2, vincristine 2 mg/day, and prednisolone 100 mg/day) and two courses of intrathecal methotrexate therapy for DLBCL, the symptoms and the lesion of enhanced Gd-MRI and fluorodeoxyglucose-positron emission tomography were completely disappeared. Conclusion: NHLs in the sphenoid sinus is very rare disease, however, it is important to be diagnosed pathologically as soon as possible for being in remission state by the chemotherapy.

Hypopituitarism and cranial nerve involvement mimicking Tolosa-Hunt syndrome as the initially presenting feature of diffuse large B-cell lymphoma: a case report

“…They also reviewed 17 cases of nasopharyngeal B-cell lymphoma, but none of the cases of nasopharyngeal B-cell lymphoma presented cranial nerve palsies nor hypopituitarism [ 3 ]. Similarly, Wajima et al reviewed 15 cases of sphenoidal lymphoma [ 5 ]; 73.3% patients initially presented with ptosis or diplopia caused by II, III, IV, or VI palsy, but not hypopituitarism. Furthermore, they reported that the most commonly extended area of tumor was the cavernous sinus (33.3%) as shown in our case [ 5 ].…”

“…Similarly, Wajima et al reviewed 15 cases of sphenoidal lymphoma [ 5 ]; 73.3% patients initially presented with ptosis or diplopia caused by II, III, IV, or VI palsy, but not hypopituitarism. Furthermore, they reported that the most commonly extended area of tumor was the cavernous sinus (33.3%) as shown in our case [ 5 ]. Together, it is clinically important to consider that sphenoidal lymphoma could simultaneously cause both hypopituitarism and hemi-cranial nerve palsies.…”

International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors

“…Systemic symptoms may be present in BCL (especially in cases with systemic involvement), while they are relatively rare in ENKTL 1794 . In a series of head and neck lymphoma patients, only 13% of ENKTL patients were diagnosed with B symptoms at the time of presentation 1795 .…”