Rhinopharyngeal B-cell non-hodgkin lymphoma: unusual presentation with massive hematemesis

Differential Diagnosis of Primary Nasopharyngeal Lymphoma and Nasopharyngeal Carcinoma Focusing on CT, MRI, and PET/CT

Objective. No study has done a comparative analysis of radiologic imaging findings between primary nasopharyngeal lymphoma (PNL) and nasopharyngeal carcinoma (NPC). The purpose of this study was to analyze computed tomography (CT) and magnetic resonance (MR) images and to evaluate the maximum standardized uptake value (SUV max) of positron emission tomography (PET)/CT between PNL and NPC, knowing the imaging features that distinguish PNL from NPC.

Study Design. Cross-sectional study.

Setting. University tertiary care facility.

Subjects and Methods. The authors analyzed the features on CT, MR imaging, and PET/CT of 16 patients diagnosed with PNL and 32 patients diagnosed with NPC histopathologically.

Results. Patients with PNL had a larger tumor volume and showed symmetry of tumor shape than did patients with NPC. Patients with PNL also had higher tumor homogeneity than NPC patients on CT, T2-weighted, and postcontrast MR images. All PNL patients showed a high degree of enhancement without invasion to the adjacent deep structure. The involvement of the Waldeyer ring was significantly higher in PNL patients. Cervical and retropharyngeal lymphadenopathy and PET/CT SUV max showed no significant difference between PNL and NPC.

Conclusions. If the images present a bulky, symmetric nasopharyngeal mass with marked homogeneity, a high degree of enhancement, and a higher Waldeyer ring involvement combined with no invasion into the deep structure, PNL should be considered over NPC.

Non-Hodgkin lymphoma with hemorrhagic necrosis of the nasopharynx mimicking an abscess

Radiologic feature of primary nasopharyngeal lymphoma is a predominantly homogenous, nonnecrotic large tumor with no or minimal deep tissue invasion. To the best knowledge, nasopharyngeal lymphoma has not been presented with hemorrhagic necrosis. Thus, we report 2 cases of nasopharyngeal lymphoma with hemorrhagic necrosis mimicking an abscess. The patients had bleeding diathesis such as aplastic anemia or idiopathic portal hypertension.