Morar Raluca, Varga Norberth Istvan, Horhat Ioana Delia, Moţ Ion Cristian, Zară Flavia, Cloşca Raluca Maria, Sarău Cristian Andrei, Sarău Oana Silvana, Costăchescu Dan, Balica Nicolae Constantin
Department of Medical Semiology I, Faculty of Medicine, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania;
Rom J Morphol Embryol. 2025 Jan-Mar;66(1):239-244. doi: 10.47162/RJME.66.1.22.
Primary lymphoma of the paranasal sinuses, especially involving the frontal sinus, is exceedingly rare. Extranodal non-Hodgkin lymphoma (NHL) located in the head and neck frequently poses diagnostic challenges because its nonspecific symptoms can be mistaken for benign issues such as rhinosinusitis.
This case report seeks to emphasize the challenges in diagnosis, the aggressive characteristics, and the effective treatment of an uncommon manifestation of diffuse large B-cell lymphoma (DLBCL) primarily affecting the frontal and ethmoid sinuses.
We present a case of a 62-year-old male who initially presented with symptoms suggestive of acute rhinosinusitis complicated by periorbital cellulitis. Diagnostic workup included physical examination, laboratory investigations, computed tomography (CT) imaging, magnetic resonance imaging (MRI), histopathological (HP) analysis of biopsy specimens, immunohistochemical staining, and positron emission tomography (PET)-CT. The patient presented with right frontal headache, periorbital edema, palpebral ptosis, and posterior rhinorrhea. Initial CT revealed mucosal thickening, lytic changes, and a mass partially invading the right orbit. Following surgical excision, histopathology confirmed DLBCL with positivity for cluster of differentiation (CD)20, CD79a, B-cell lymphoma (Bcl)-6, and Bcl-2, and a Ki-67 proliferation index of 90%. Subsequent MRI revealed a hypointense mass extending into surrounding structures. Staging CT confirmed stage IVB disease. The patient received six cycles of Rituximab-Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Oncovin (Vincristine), Prednisolone (R-CHOP) chemotherapy and radiotherapy for the frontal sinus. At the 6-month and 12-month follow-up CT scans, there was no evidence of metabolically active disease on PET-CT (Deauville score 1). During the 2-year follow-up, the patient remained in complete remission.
This case underscores the importance of considering malignancy in cases of atypical sinusitis and the crucial role of HP examination of biopsy specimens. This case also highlights the importance of considering malignancy in cases of atypical sinusitis.
鼻窦原发性淋巴瘤，尤其是累及额窦的情况极为罕见。头颈部的结外非霍奇金淋巴瘤（NHL）常常带来诊断挑战，因为其非特异性症状可能被误诊为鼻窦炎等良性疾病。
本病例报告旨在强调弥漫性大B细胞淋巴瘤（DLBCL）一种罕见表现的诊断挑战、侵袭性特征及有效治疗，该表现主要累及额窦和筛窦。
我们报告一例62岁男性患者，最初表现为提示急性鼻窦炎并伴有眶周蜂窝织炎的症状。诊断检查包括体格检查、实验室检查、计算机断层扫描（CT）成像、磁共振成像（MRI）、活检标本的组织病理学（HP）分析、免疫组化染色以及正电子发射断层扫描（PET）-CT。患者出现右侧额部头痛、眶周水肿、眼睑下垂及鼻后溢液。初始CT显示黏膜增厚、溶骨性改变以及一个部分侵犯右侧眼眶的肿块。手术切除后，组织病理学确诊为DLBCL，其分化簇（CD）20、CD79a、B细胞淋巴瘤（Bcl）-6和Bcl-2呈阳性，Ki-67增殖指数为90%。随后的MRI显示一个低信号肿块延伸至周围结构。分期CT确诊为IVB期疾病。患者接受了六个周期的利妥昔单抗-环磷酰胺、羟基柔红霉素（阿霉素）、长春新碱、泼尼松龙（R-CHOP）化疗以及额窦放疗。在6个月和12个月的随访CT扫描中，PET-CT未发现代谢活跃疾病的证据（迪厄多内评分1）。在2年的随访期间，患者一直处于完全缓解状态。
本病例强调了在非典型鼻窦炎病例中考虑恶性肿瘤的重要性以及活检标本HP检查的关键作用。本病例还突出了在非典型鼻窦炎病例中考虑恶性肿瘤的重要性。
