Lymphoma Maxilla mimicking orbital cellulitis; case report and review of Literature

Abstract

Background: Sinonasal lymphomas are the commonest nonepithelial malignancies of the nasal cavity and paranasal sinuses. They may spread from their site of origin in nasal cavity and invade adjacent structures including orbits leading to varying presentation and a diagnostic dilemma. Case: A-77-year old Nepalese male presented with swelling of left eye since 1 month and pain in the same eye since 2 days. Observation: Examination revealed axial proptosis, swelling of lids, restricted extraocular movement, diffuse conjunctival and ciliary congestion with chemosis. Visual acuity was grossly decreased. The case was diagnosed as left orbital cellulitis and treated with broad spectrum intravenous antibiotics and oral steriods. There was no response despite 3 days of antibiotics and steroids therefore a computed tomography was planned which showed features of Sinonasal malignancy invading the orbit. Repeated biopsy was suggestive of malignant small round cell tumour. In the view of unclear preoperative biopsy indicating further details on the histologic type of tumor and extensive erosion of maxilla with complete loss of vision in the eye the patient was planned for Total Maxillectomy with Orbital extenteration of the left orbit. Post-operative histopathological and Immunohistochemical report were suggestive of High grade Lymphoma. The patient was advised for Adjuvant Chemotherapy and Radiotherapy, which the patient refused due to financial constraints. He is on occasional follow up since the last 6 months. Conclusions: The diagnosis of maxillary sinus lymphoma needs to be borne in mind when a clinician encounters a case of Orbital Cellulitis. It may be difficult to diagnose clinically and require radio-pathological correlation.

To What Extent Can Orbital Cellulitis Emergency Aspect Influence the Diagnosis of Maxillary Sinus Lymphoma?

“…Indeed, though it is exceptional, maxillary lymphoma may mimic orbital cellulitis. To our knowledge, our observation describes the third case of orbital cellulitis revealing maxillary lymphoma [3,6]. In fact, this tumoral entity is generally insidious with myriad presentations and it is revealed in most cases by sinonasal nonspecific signs [7].…”

“…However, the clinician should stay vigilant when considering infectious disease diagnosis. Indeed, although it is extremely rare, orbital cellulitis can hide a maxillary lymphoma and lead to late diagnosis [3].…”

Orbital Lymphoma Masquerading as Orbital Cellulitis

“…Lymphoma of orbit can masquerade as orbital cellulitis [14][15][16][17]. The pathophysiology behind orbital lymphoma presenting as orbital cellulitis can be due to direct tumor invasion responsible for inflammation of orbital soft tissues [17].…”

“…Lymphoma of orbit can masquerade as orbital cellulitis [14][15][16][17]. The pathophysiology behind orbital lymphoma presenting as orbital cellulitis can be due to direct tumor invasion responsible for inflammation of orbital soft tissues [17]. Orbital cellulitis is an infectious condition of the orbital soft tissues posterior to the orbital septum.…”