Chowdhury D, Rahman A, Rashid M H, Chaurasia B, Kamal M, Barua K K
Dr Dhiman Chowdhury, Associate Professor, Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh; E-mail: dhiman_ns@ yahoo.com.
Mymensingh Med J. 2018 Oct;27(4):888-893.
Lymphomas are group of malignant neoplasm having origins from lymphoreticular cells. B cell Non Hodgkin Lymphoma (BNHL) of sphenoid sinus as primary site for lymphomas are very rare and whenever involves comes usually with ocular manifestations. The proximity of the lesion to optic nerve and cavernous sinus present a high risk of developing unilateral ophthalmoplegia or even blindness. The vast majority of cases of localized sphenoid sinus lymphomas are usually curable to surgery, chemotherapy alone or combination of both, sometimes radiotherapy. Here we report a case of 58 years old male attended at Bangabandhu Sheikh Mujib Medical University (BSMMU) on 9th February 2017 at 9:00 AM having headache and gradually developing ptosis in left eye over 15 days. MRI of brain revealed homogeneously enhancing lesion occupying sphenoid sinus, clivus extending towards left cavernous sinus. Gross total resection of tumor was achieved by endoscopic endonasal approach. Histopathology revealed non-Hodgkin lymphoma and immunohistochemically it was positive for CD 20, CD 45, CD 79 and BCL 2, strongly compatible with diffuse large B cell lymphoma. Treatment with R-CHOP regimen following surgery resulted in initiation of improvement of the condition of the patient. Primary B cell Non-Hodgkin Lymphoma (PBNHL) of the sphenoid sinus is a rare entity which can be perplexing and misleading for a surgeon until the histopathological proof is in hand. Early diagnosis with strong suspicion of sphenoid lymphoma in mind during workouts and timely management, close monitoring and follow ups have high potential for cure and longer disease-free survival of the BNHL patients.
淋巴瘤是一组起源于淋巴网状细胞的恶性肿瘤。蝶窦原发性B细胞非霍奇金淋巴瘤（BNHL）作为淋巴瘤的原发部位非常罕见，一旦累及通常伴有眼部表现。病变靠近视神经和海绵窦，存在发生单侧眼肌麻痹甚至失明的高风险。绝大多数局限性蝶窦淋巴瘤病例通常可通过手术、单纯化疗或两者联合治愈，有时还需放疗。在此，我们报告一例58岁男性患者，于2017年2月9日上午9点就诊于孟加拉国谢赫·穆吉布医学大学（BSMMU），患者有头痛症状，并在15天内左眼逐渐出现上睑下垂。脑部MRI显示蝶窦、斜坡有均匀强化病变，病变向左侧海绵窦延伸。通过鼻内镜经鼻入路实现了肿瘤的全切除。组织病理学显示为非霍奇金淋巴瘤，免疫组化显示CD 20、CD 45、CD 79和BCL 2呈阳性，与弥漫性大B细胞淋巴瘤高度相符。术后采用R-CHOP方案治疗使患者病情开始好转。蝶窦原发性B细胞非霍奇金淋巴瘤（PBNHL）是一种罕见的疾病，在获得组织病理学证据之前，对外科医生来说可能会感到困惑和误导。在检查过程中高度怀疑蝶窦淋巴瘤并进行早期诊断，及时进行管理、密切监测和随访，对BNHL患者有很高的治愈潜力和更长的无病生存期。
