Primary lymphomas of the nasal cavity and paranasal sinuses

Abstract

Extranodal lymphomas which present in the nasal cavity and/or the paranasal sinuses are rare. Thirty-eight patients with disease that was clinically limited to the head and neck (Ann Arbor Stages IE-IIE) were admitted between 1947 and 1983. Twenty-eight patients were treated with radiotherapy alone and 10 received combination chemotherapy in addition. The overall 5-year survival figure was 56%. The corresponding result for Stage IE was 67%. No patient with Stage IIE disease survived 5 years. Extent of the extranodal disease also influenced results for Stage IE patients who were treated with radiotherapy only. When the extranodal disease was staged using the American Joint Committee TNM system, the 5-year disease-free survival for T1 and T2 patients was 78% as compared with 19% for patients with T3 and T4 disease. The addition of combination chemotherapy improved results for patients with T3 and T4 lesions. Cancer 56:814-819, 1985. YMPHOMAS originating in the nasal cavity and/or L the paranasal sinuses are very uncommon. Gall and Mallory' reported only 2 cases from a series of 6 18 malignant lymphomas (0.3%) and Freeman et al.' cited 33 cases in a series of 1467 non-Hodglun's lymphomas (2%). Wong er al.' in a previous study of 128 patients with extranodal lymphomas of the head and neck found 16 (1 3%) cases. The incidence of lymphoma in relation to other malignant tumors of the nasal cavity and associated sinuses is also low representing less than Also, lymphomas presenting in this region are almost exclusively non-Hodgkin's lymphomas. The diffuse large cell variety is by far the most common.

Local tumor invasiveness is more predictive of survival than International Prognostic Index in stage IE/IIE extranodal NK/T-cell lymphoma, nasal type

“…Robbins et al 17 previously reported that 5-year DFS was shortened in advanced T stages using the tumor-node-metastasis (TNM) staging system in stage I E /II E lymphomas of nasal cavity and paranasal sinuses. Similarly, Logsdon et al 18 reclassified stage I E into T stages according to the extent of the disease and showed that early T stages improved freedom from progression in patients treated with radiation therapy.…”

“…Despite lack of immunophenotyping, the 2 studies used the TNM staging system and focused on the extent of the lymphoma, including bone destruction. 18 The majority of studies to date showed the local invasive nature of nasal lymphomas extending to adjacent anatomic structures 14,17,18,23,24 and destroying bone structures. 6,16,25 Paranasal extension was a significant predictive factor of survival in several studies, 17,18,26,27 whereas Cheung et al 28 reported no prognostic significance of paranasal extension or the significance of bony invasion.…”

“…6,[14][15][16] The extent of nasal lymphoma was considered as a prognostic factor in a few studies. 17,18 Therefore, we aimed to compare the prognostic accuracies of a system based on local tumor invasiveness (LTI) with the existing Ann Arbor stage and the IPI, which has been shown to correlate with survival in recent studies in nasal stage I E /II E NTCL. 13,19 Patients, materials, and methods…”

Natural killer-cell malignancies: diagnosis and treatment

“…Therefore, nasal NK-cell lymphomas involving extensively the nasal cavity, paranasal sinuses and nasopharynx would still be considered as stage I E disease. 21,11,[33][34][35][36][37][38][39] To overcome this problem, a staging system devised originally for conventional sinonasal B-cell lymphomas 40 has been tested in nasal NK-cell lymphomas. Initial results showed that stage T1/T2 diseases had superior outcome compared with stage T3/T4 diseases.…”

“…33,39,40 Furthermore, nasal NK-cell lymphomas not responding to chemotherapy can be salvage by radiotherapy in about 50% of cases. In contrast, patients failing radiotherapy respond minimally to salvage chemotherapy.…”