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Knudson SA, Day KM, Harshbarger RJ. Pediatric Diffuse Large B-Cell Lymphoma of the Frontal Sinus: A Case Report. Cleft Palate Craniofac J 2019; 56:1089-1095. [PMID: 30836788 DOI: 10.1177/1055665619831165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
An 11-year-old male presented with right proptosis, bulbar conjunctivitis, and diplopia. Computerized tomography (CT) and magnetic resonance imaging revealed an enhancing mass involving the superio-medial orbit, ethmoids, frontal sinus, and anterior cranial fossa with skull base destruction. Diffuse large B-cell lymphoma was diagnosed via CT-guided biopsy. As a component of multidisciplinary care, the patient underwent frontal sinus cranialization, with orbital and skull base reconstruction. Trauma reconstructive principles guided recreation of orbital, frontal sinus, and anterior skull base anatomy. This rare primary location is undescribed in the pediatric literature.
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Affiliation(s)
| | - Kristopher M Day
- 2 Department of Craniofacial and Pediatric Plastic Surgery, Dell Children's Medical Center of Central Texas, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Raymond J Harshbarger
- 2 Department of Craniofacial and Pediatric Plastic Surgery, Dell Children's Medical Center of Central Texas, The University of Texas at Austin Dell Medical School, Austin, TX, USA
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2
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Steele TO, Buniel MC, Mace JC, El Rassi E, Smith TL. Lymphoma of the nasal cavity and paranasal sinuses: A case series. Am J Rhinol Allergy 2017; 30:335-9. [PMID: 27657899 DOI: 10.2500/ajra.2016.30.4347] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Lymphomas of the sinonasal tract are a rare and heterogeneous subset of solid sinonasal neoplasms. OBJECTIVE To characterize, in this case series, presenting symptoms, treatment modalities, and outcomes for patients with sinonasal lymphoma within a single institution. METHODS Retrospective patient data were collected from an academic, oncologic center and entered into a repository designed to capture outcomes for sinonasal malignancies. Patient demographics, presenting symptoms, imaging findings, treatment modalities, and health status were retrospectively extrapolated and evaluated by using Kaplan-Meier estimations for survival probability. RESULTS Patients with sinonasal lymphoma with a mean follow-up of 50 months were identified (n = 18). Histologic diagnosis included the following: diffuse large B-cell lymphoma (n = 9), natural killer/T-cell lymphoma (n = 5), follicular lymphoma (n = 1), T-cell lymphoma (n = 1), and lymphoma-not otherwise specified (n = 2). The most frequent presenting symptoms were nasal obstruction (78%), facial pain (72%), facial swelling (50%), and nasal discharge (44%). Treatment before lymphoma diagnosis included antibiotics (83%), oral steroids (22%), decongestants (22%), and topical steroids (11%). Treatment regimens after diagnosis included both chemotherapy (94%) and chemoradiotherapy (56%). Survival rates by lymphoma subtype were 56% for B-cell lymphoma and 40% for natural killer/T-cell lymphoma. Overall, 2- and 5-year survival rates were 67% and 50%, respectively. The combination of chemotherapy and radiation resulted in significantly higher survival rates (p ≤ 0.001) than chemotherapy alone. CONCLUSION Sinonasal lymphomas are characterized by meager survival rates, which differ by histopathologic subtype. The diagnosis of sinonasal lymphoma is challenging because symptoms frequently parallel those of chronic rhinosinusitis. Increased awareness of these rare malignancies may improve detection and more timely treatment. Clinical trial registration NCT01332136.
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Affiliation(s)
- Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, USA
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Clinical findings of extranodal SNT lymphoid malignancies in a four-decade single-centre series. Eur Arch Otorhinolaryngol 2016; 273:3839-3845. [PMID: 27010643 DOI: 10.1007/s00405-016-3992-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 03/15/2016] [Indexed: 01/01/2023]
Abstract
Sinonasally located lymphoid malignancies are rare lesions with first symptoms similar to other obstructive conditions. Additionally, they often coexist with nasal inflammation and mucosal necrosis. Therefore, time from the first symptoms to diagnosis tends to be long. Awareness and early diagnosis of this disease entity could improve treatment outcome. Altogether, 142 patients with sinonasal or nasopharyngeal (i.e. sinonasal tract, SNT) lymphoid malignancies, diagnosed and treated at the Helsinki University Hospital, during a 39-year period from 1975 to 2013, were retrospectively reviewed. There were 90 males (63 %) and 52 females (37 %) with a median age of 64 years (range 26-92). Eighty-four percent of the patients had primary diseases and 16 % had relapses of lymphoid malignancies primarily diagnosed at other locations. The mean duration of symptoms prior to diagnosis was 4.8 months (range 0.5-24). The most common histological entity was diffuse large B-cell lymphoma (43 %), followed by plasmacytoma (18 %). The most common location was nasopharynx (58 %) followed by nasal cavity (44 %) and paranasal sinuses (35 %). Sixty-nine percent of the lesions were at a single anatomic location of the sinonasal tract. Fifty-two percent of the cases were of Ann Arbor Stage I. Lymphoid malignancies form an important and diverse group in the differential diagnosis of SNT tumours. They most often present with general obstructive nasal symptoms due to tumour location. Most of them are primary lesions, highlighting the importance of an accurate diagnosis as early as possible.
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Lombard M, Michel G, Rives P, Moreau A, Espitalier F, Malard O. Extranodal non-Hodgkin lymphoma of the sinonasal cavities: A 22-case report. Eur Ann Otorhinolaryngol Head Neck Dis 2015; 132:271-4. [PMID: 26363601 DOI: 10.1016/j.anorl.2015.08.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To determine presenting features, management and prognosis in extranodal non-Hodgkin lymphoma of the sinonasal tract. MATERIAL AND METHODS A retrospective study between 2004 and 2013 in the University Hospital Center of Nantes (France) recruited patients with lymphoma discovered by sinonasal involvement. Epidemiologic, diagnostic, clinical and prognostic criteria were analyzed, with survival studied on the Kaplan-Meier estimator and Log-rank test. RESULTS Twenty-two patients were included: 14 male, 7 female, with a mean age of 65 years at diagnosis. All had non-Hodgkin lymphoma, with strong predominance of diffuse large B-cell lymphoma (77%). Seven patients had risk factors for lymphoma (infection by HIV, EBV or chronic lymphocytic leukemia). A majority (68%) had advanced tumor at diagnosis (stage IV on the Ann Arbor classification). Most were located in the craniofacial bones (68%), mainly involving the maxillary or ethmoidal sinuses. The most frequent presenting symptoms were unilateral nasal obstruction, mucopurulent rhinorrhea, recurrent epistaxis or diplopia. Treatment consisted in chemotherapy, in some cases associated to radiotherapy. Overall survival was 82% at 12 months and 73% at 36 months. Recurrence-free survival was 76% at 12 months and 64% at 36 months. CONCLUSION Lymphoma is an aggressive pathology; revelation by sinonasal involvement is rare. Recommended treatment is chemotherapy, possibly associated to radiotherapy. Prognosis depends on histologic type, Ann Arbor stage at diagnosis and the therapeutic options available for the individual patient.
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Affiliation(s)
- M Lombard
- Service d'ORL et de chirurgie cervico-faciale, centre hospitalier universitaire de Nantes, Hôtel-Dieu, 1, place A.-Ricordeau, BP 1005, 44093 Nantes cedex 01, France
| | - G Michel
- Service d'ORL et de chirurgie cervico-faciale, centre hospitalier universitaire de Nantes, Hôtel-Dieu, 1, place A.-Ricordeau, BP 1005, 44093 Nantes cedex 01, France
| | - P Rives
- Service d'ORL et de chirurgie cervico-faciale, centre hospitalier universitaire de Nantes, Hôtel-Dieu, 1, place A.-Ricordeau, BP 1005, 44093 Nantes cedex 01, France
| | - A Moreau
- Service d'anatomopathologie, centre hospitalier universitaire de Nantes, Hôtel-Dieu, 1, place A.-Ricordeau, BP 1005, 44093 Nantes cedex 01, France
| | - F Espitalier
- Service d'ORL et de chirurgie cervico-faciale, centre hospitalier universitaire de Nantes, Hôtel-Dieu, 1, place A.-Ricordeau, BP 1005, 44093 Nantes cedex 01, France
| | - O Malard
- Service d'ORL et de chirurgie cervico-faciale, centre hospitalier universitaire de Nantes, Hôtel-Dieu, 1, place A.-Ricordeau, BP 1005, 44093 Nantes cedex 01, France.
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Khan NR, Lakičević G, Callihan TR, Burruss G, Arnautović K. Diffuse Large B-Cell Lymphoma of the Frontal Sinus Presenting as a Pott Puffy Tumor: Case Report. J Neurol Surg Rep 2015; 76:e23-7. [PMID: 26251804 PMCID: PMC4520977 DOI: 10.1055/s-0034-1543996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 07/18/2014] [Indexed: 02/08/2023] Open
Abstract
Objective Sinonasal non-Hodgkin lymphoma (NHL) is a very rare condition. NHL located specifically in the frontal sinus is even rarer with only 14 cases in the literature reported to date. A unique case of diffuse large B-cell lymphoma of the frontal sinus that presented first and was treated as suspected Pott puffy tumor is presented along with a review of the literature. Case Report A 69-year-old white man with a history of sinusitis and two recent endoscopic sinus surgeries presented with enlargement of his right forehead. Computed tomography and magnetic resonance images revealed a dense opacification of the frontal sinus bilaterally, thickening and enhancement of the dura mater behind the right frontal sinus, and local osteomyelitis-like lytic bone changes. A bifrontal craniotomy was performed. Radical exoneration of the frontal sinus, copious antibiotic-impregnated irrigation after culture swabs, and resection of presumed granulation tissue was performed. Culture swabs remained negative, but histopathology revealed diffuse large B-cell lymphoma. Subsequent chemotherapy was administered. Conclusion Sinonasal NHL is very rare but can occur in the frontal sinus and may present as a suspected Pott puffy tumor. A high clinical suspicion is necessary for early diagnosis and treatment.
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Affiliation(s)
- Nickalus R Khan
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Goran Lakičević
- Department of Neurosurgery, University Hospital Mostar, Bosnia and Herzegovina
| | | | - George Burruss
- Department of Plastic Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Kenan Arnautović
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States ; Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, United States
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Peng KA, Kita AE, Suh JD, Bhuta SM, Wang MB. Sinonasal lymphoma: case series and review of the literature. Int Forum Allergy Rhinol 2014; 4:670-4. [PMID: 24760602 DOI: 10.1002/alr.21337] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 03/06/2014] [Accepted: 03/23/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND Sinonasal lymphoma is a rare rhinologic entity. We present a case series and review the literature surrounding the diagnosis and management of this disease. METHODS A pathology database spanning 22 years at a tertiary care center was searched for a diagnosis of lymphoma in the paranasal sinuses or the nasal cavity. Seventeen cases were identified, and retrospective chart review was performed. RESULTS Maxillary and ethmoid sinuses were affected more frequently (n = 8 patients each) than sphenoid and frontal sinuses (n = 5 patients each). Histologically, the most common type was diffuse large B-cell lymphoma (53%, 9 patients), followed by extranodal natural killer/T-cell lymphoma (ENKL, 21%, 3 patients). Presenting symptoms included nasal obstruction and rhinorrhea (53%, 9 patients) and diplopia (18%, 3 patients); and radiographic imaging demonstrated a discrete mass (59%, 10 patients), sinus opacification (53%, 9 patients), and/or bony erosion (35%, 6 patients). Treatment included chemotherapy alone (71%, 12 patients), chemotherapy and radiation (6%, 1 patient), and radiation alone (6%, 1 patient). The 2-year and 5-year overall survival rates were 75% and 53%, respectively, whereas disease-free 2-year and 5-year survival rates were 70% and 49%, respectively. CONCLUSION Lymphoma of the nasal cavity and paranasal sinuses is extremely rare, may mimic benign processes, and may manifest either in an isolated fashion or in conjunction with systemic disease. B-cell lymphomas, a more favorable diagnosis, account for a majority of cases, whereas ENKL is associated with rapid disease progression and death. Chemotherapy and radiation are the main therapies. Histologic diagnosis is of paramount importance, and clinicians must remain cognizant of this entity to differentiate it from other sinonasal malignancies.
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Affiliation(s)
- Kevin A Peng
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
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Unilateral non-Hodgkin's lymphoma of the frontal sinus presenting as Pott's puffy tumour. Otolaryngol Pol 2013; 67:214-7. [DOI: 10.1016/j.otpol.2012.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 11/28/2012] [Indexed: 11/19/2022]
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Primary non-Hodgkin lymphoma in the pterygopalatine fossa. A peculiar diagnosis with a minimally invasive endoscopic approach. Ann Hematol 2013; 93:345-6. [PMID: 23743538 DOI: 10.1007/s00277-013-1801-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Accepted: 05/18/2013] [Indexed: 10/26/2022]
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Compressive Optic Neuropathy Caused by Orbital Non-Hodgkin's Lymphoma. Case Rep Ophthalmol Med 2012; 2012:894062. [PMID: 22606505 PMCID: PMC3350013 DOI: 10.1155/2012/894062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 01/18/2012] [Indexed: 11/18/2022] Open
Abstract
Purpose. To present a unique case of Non-Hodgkin's-Lymphoma- (NHL) associated compressive optic neuropathy. Method. An 89-year-old male presenting with acute unilateral visual loss and headache. Results. Patient was initially diagnosed with occult giant cell arteritis; however after visual acuity deteriorated despite normal inflammatory markers, an urgent MRI scan revealed an extensive paranasal sinus mass compressing the optic nerve. Conclusion. Paranasal sinus malignancies occasionally present to the ophthalmologist with signs of optic nerve compression and must be included in the differential diagnosis of acute visual loss.
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Abstract
Primary frontal sinus lymphoma is a very uncommon disease. In all the previously reported cases, the presenting symptoms have been due to the tumor mass effect. We present an unusual case report of an immunocompetent patient who presented with facial palsy, and then progressively developed other cranial nerve palsies over several months. He was later diagnosed with diffuse large B cell lymphoma originating from the frontal sinus. The patient underwent chemotherapy, but eventually had to receive autologous peripheral blood stem cell transplantation. He is currently disease-free. The clinical course, diagnostic workup, and therapeutic outcome are described.
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Affiliation(s)
- Kyubo Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Min Ju Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Sanghyeon Ahn
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - So Young Bae
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Seog Kim
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo-Heon Yoon
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
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11
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Lee YJ, Lim JH, Lew H. A Case of Paranasal Diffuse Large B-Cell Lymphoma with the Orbital Invasion Masquerading as Chronic Sinusitis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2011. [DOI: 10.3341/jkos.2011.52.11.1351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Young Ji Lee
- Department of Opthalmology, The institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea
| | - Ji He Lim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Helen Lew
- Department of Opthalmology, Bundang CHA Medical Center, CHA University, Seongnam, Korea
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12
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Burkitt's Lymphoma of maxillary sinuses: review of literature and report of bilateral case. J Oral Maxillofac Surg 2009; 67:1755-63. [PMID: 19615595 DOI: 10.1016/j.joms.2009.03.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Accepted: 03/25/2009] [Indexed: 01/17/2023]
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13
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Peleg A, Heran MKS, White VA, Chang WY, Rootman J. Malignant lymphoproliferative disorders extending into the orbit from the paranasal sinuses. Orbit 2009; 28:80-87. [PMID: 19839889 DOI: 10.1080/01676830802656869] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND/AIMS To describe the clinical features, imaging, histologic spectrum, treatment and prognosis of patients with malignant orbital lymphoproliferative disorders extending from the paranasal sinuses. METHODS Patients were culled from the University of British Columbia Orbit Clinic (1977-2004) and their clinical charts, imaging and pathology specimens reviewed. RESULTS The study included 6 patients with non-Hodgkin's lymphoma (NHL) and 5 multiple myeloma (MM). Orbital symptoms at presentation were periorbital swelling, diplopia, proptosis and pain. Major clinical findings were globe displacement, abnormal ocular movements, periorbital fullness, fifth nerve hypoesthesia and inflammatory signs. Imaging showed a soft tissue mass in one or more sinuses invading the orbit. Three NHL patients were still alive at last follow-up with one patient lost to follow-up. Two NHL patients and all MM died. CONCLUSION Presenting symptoms of malignant orbital lymphoproliferative disorders extending from the paranasal sinuses include mass effect occasionally with infiltrative and inflammatory characteristics accompanied by symptoms of sinus disease. On imaging, a soft tissue mass in the sinuses and orbit with bone destruction is commonly seen. Biopsy is essential for conclusive diagnosis. Treatment should be initiated promptly as local symptoms are frequently relieved and survival is possible, especially in cases of NHL.
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Affiliation(s)
- Alan Peleg
- University of British Columbia and the Vancouver General Hospital, Canada
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Anand TS, Saxena YK, Shashidhar TB, Kumar S. Primary B cell lymphoma of paranasal sinuses: a diagnostic surprise. Indian J Otolaryngol Head Neck Surg 2008; 60:256-8. [PMID: 23120556 PMCID: PMC3450634 DOI: 10.1007/s12070-008-0087-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Primary lymphomas of paranasal cavities are rather uncommon entities. They have a variable presentation from fulminant destructive manifestations to chronic indolent type of disease. Chronic indolent form may mimic invasive fungal sinusitis in its presentation. Unless high index of suspicion is held and appropriate histopathology sections are taken from specimen, its diagnosis can be deceitful. We here by report a case of primary lymphoma of the paranasal sinuses which was radiologically and clinically suspected to be a invasive fungal sinusitis and later was proven to be a B cell lymphoma. Clinical similarities between lymphoma and invasive fungal sinusitis along with management issues are discussed in this article.
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Affiliation(s)
- T. S. Anand
- 4, Hemkunt Colony, Opp. Eros International Hotel, Nehru Place, New Delhi 110 048 India
| | - Y. K. Saxena
- 4, Hemkunt Colony, Opp. Eros International Hotel, Nehru Place, New Delhi 110 048 India
| | - T. B. Shashidhar
- 4, Hemkunt Colony, Opp. Eros International Hotel, Nehru Place, New Delhi 110 048 India
| | - Soumitra Kumar
- 4, Hemkunt Colony, Opp. Eros International Hotel, Nehru Place, New Delhi 110 048 India
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Pyatt D, Natelson E, Golden R. Is inhalation exposure to formaldehyde a biologically plausible cause of lymphohematopoietic malignancies? Regul Toxicol Pharmacol 2008; 51:119-33. [DOI: 10.1016/j.yrtph.2008.03.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Revised: 02/26/2008] [Accepted: 03/05/2008] [Indexed: 11/25/2022]
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Nagasaki A, Miyagi T, Taira T, Shinhama A, Kojya S, Suzuki M, Aonahata M, Yoshimi N, Takasu N. Adult T-cell leukemia/lymphoma with multiple integration of HTLV-1 provirus presenting as an isolated paranasal sinus tumor: A case report. Head Neck 2008; 30:815-20. [DOI: 10.1002/hed.20730] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Sordet C, Mrabet D, Ardizzone M, Marcellin L, Hirschorn P, Sibilia J. A centrofacial B lymphoma in a rheumatoid arthritis patient. Eur J Intern Med 2007; 18:71-3. [PMID: 17223048 DOI: 10.1016/j.ejim.2006.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2006] [Accepted: 04/27/2006] [Indexed: 11/27/2022]
Abstract
We report on a 65-year-old man who was hospitalized for polyarthritis with deterioration of his general state of health and chronic sinusitis. Clinical and biological signs led to the diagnosis of RA associated with localized Wegener's granulomatosis. Methotrexate and corticosteroids led to a distinct improvement in the patient's articular symptoms and in his general condition. One year after the start of treatment, a tumefaction of the right maxillary sinus appeared. Scans revealed a tumoral lesion in the right maxillary sinus. This proved to be a large B-cell lymphoma. The patient received chemotherapy (CHOP) and radiotherapy. This centrofacial lymphoma may be regarded as a B lymphoma of the MALT (mucosal associated lymphoma tumor) type, mimicking a relapse of Wegener's granulomatosis.
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Affiliation(s)
- Christelle Sordet
- Department of Rheumatology, CHU Strasbourg, 67098 Strasbourg Cedex, France; ORL, CHU Strasbourg, 67098 Strasbourg Cedex, France
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Chain JR, Kingdom TT. Non-Hodgkin's lymphoma of the frontal sinus presenting as osteomyelitis. Am J Otolaryngol 2007; 28:42-5. [PMID: 17162131 DOI: 10.1016/j.amjoto.2006.06.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2006] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The aim of the study was to present a case of non-Hodgkin's lymphoma (NHL) originating in the frontal sinus that presented as osteomyelitis of the frontal bone. METHODS A review of a single case including radiographic, intraoperative, and pathologic findings was done, followed by a discussion highlighting relevant literature. RESULTS A 55-year-old man presented with pain and swelling of the forehead with 8 weeks duration. He had a history of chronic rhinosinusitis and underwent endoscopic maxillary antrostomies 4 years prior. A presumptive diagnosis of frontal sinusitis with osteomyelitis was made and prolonged oral antibiotic therapy started. The patient was referred to our center after symptoms and objective findings failed to improve. Computed tomography revealed a destructive process of the frontal bone with near total opacification of the frontal sinuses. An exploratory external frontal sinusotomy was performed revealing an infiltrative soft tissue mass filling most of the frontal sinus. Dehiscence of the posterior table was noted without dural involvement. Pathology of this mass revealed diffuse large B-cell lymphoma of intermediate grade. The patient underwent 6 cycles of chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone; radiotherapy to the frontal bone; and central nervous system prophylaxis via intrathecal methotrexate. Clinically, he fell into the Ann Arbor Stage II EA NHL category because of an isolated axillary lymph node. Now, 18 months after completion of therapy he is without evidence of disease based on serial positron emission tomography and computed tomography scanning. CONCLUSIONS We describe a case of NHL of the frontal sinus, which presented as osteomyelitis. We highlight important features of this patient's clinical presentation that can help differentiate an inflammatory process from a neoplastic process in the frontal bone. Timely diagnosis is critical, and neoplasms of the frontal sinus can be easily misdiagnosed as inflammatory.
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Affiliation(s)
- Jeffrey R Chain
- Department of Otolaryngology, University of Colorado Health Sciences Center, Denver, CO, USA
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Abstract
The purpose of this article is to review the current data on the risk of CNS relapse in patients with lymphoma and the efficacy of CNS directed prophylactic therapy. CNS relapse occurred in 30-50% of those with Burkitt lymphoma and acute lymphoblastic leukaemia/lymphoma prior to the introduction of intensified regimens that include CNS prophylaxis. Most patients with AIDS-related-lymphoma receive a short course of intrathecal prophylaxis but a re-evaluation of type and targeting of CNS prophylaxis is needed. Patients with diffuse large B-cell lymphoma (DLBCL) have a 5% overall risk of CNS relapse but a high risk sub-population can be identified on the basis of raised LDH and >1 extranodal site, testicular or primary breast involvement. CNS prophylaxis for selected patients with DLBCL may be justified by risk but its benefit is not yet proven. Intravenous methotrexate > or = 3 g/m(2) achieves therapeutic levels in CSF and parenchyma and in combination with intrathecal methotrexate would be a reasonable option for prophylaxis.
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Affiliation(s)
- Quentin A Hill
- HMDS Laboratory, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK.
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Liang CW, Li HY, Chang KP, Chen CK, Chen YL. HIV infection initially presenting as sinonasal Burkitt's lymphoma. Am J Otolaryngol 2006; 27:433-5. [PMID: 17084232 DOI: 10.1016/j.amjoto.2006.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2005] [Indexed: 11/30/2022]
Abstract
Burkitt's lymphoma is a common comorbidity of infection with the human immunodeficiency virus, but rarely the initial clinical manifestation of undiagnosed AIDS, especially for the otolaryngologist. We report the case of a patient with recalcitrant rhinosinusitis subsequently diagnosed with sinonasal Burkitt's lymphoma and HIV.
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Affiliation(s)
- Chih-Wei Liang
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taiwan, ROC
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Laskin JJ, Savage KJ, Voss N, Gascoyne RD, Connors JM. Primary paranasal sinus lymphoma: natural history and improved outcome with central nervous system chemoprophylaxis. Leuk Lymphoma 2006; 46:1721-7. [PMID: 16263574 DOI: 10.1080/17402520500182345] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Non-Hodgkin's lymphoma of the paranasal sinus is an uncommon presentation of extranodal lymphoma. Its natural history, treatment and prognosis have been infrequently characterized in the medical literature; however, a tendency to involve the central nervous system (CNS) has been noted. In British Columbia (population 4 million), a central database for lymphomas has allowed us to accurately track cases of paranasal sinus lymphoma diagnosed since 1980. A retrospective review was performed on the 44 patients who presented with primary paranasal sinus lymphoma (stage I or II) between 1980 and 1999. Histologic features were identified and immunophenotypic classification performed. Complete diagnostic and follow-up data including stage, treatment, response rates, sites of relapse and survival data were available for all patients. There were 26 men and 18 women. The types of lymphoma found were: diffuse large B cell (including immunoblastic), n = 37 (84%); T/NK nasal type, n = 3 (8%); peripheral T cell, not otherwise classified, n = 2 (4%); and others, n = 2 (4%). The median age at presentation was 66 years (range 27-97 years). The median follow-up for living patients was 114 months. For all 44 patients, the 5- and 10-year overall survivals were 48% and 41% and the disease-specific survivals 62% and 62%, respectively. Beginning in May 1985, intrathecal chemotherapy was added to our standard treatment plan of multi-agent chemotherapy and local irradiation. Before 1985, 2 of 5 patients developed leptomeningeal metastasis. Following the institution of intrathecal chemotherapy, only 8% (3 of 39) of patients have developed CNS disease. Introduction of intrathecal chemoprophylaxis was also associated with an improvement in overall survival from 20% to 51% and disease-specific survival from 40% to 65%. Primary paranasal sinus lymphoma is an uncommon presentation of lymphoma that carries the potential risk of spreading to the leptomeninges. Treatment with combined modality chemotherapy and irradiation can cure many patients and the addition of intrathecal chemotherapy may reduce the risk of CNS relapse.
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Affiliation(s)
- Janessa J Laskin
- Division of Medical Oncology, University of British Columbia and the British Columbia Cancer Agency, Vancouver, BC, Canada.
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