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Letter to the Editor Favorable outcome in non-Hodgkin lymphoma of the maxillary sinus treated with R-CHOP

Year: 2013

Type: letter

Abstract: Non-Hodgkin lymphoma (NHL) accounts for less than 1% of all head and neck malignancies, although this anatomic location is the second most common extranodal site for NHL, lagging behind only the GI tract.Specifically, in the sinonasal tract, NHL is a common neoplasm, while its overall incidence ranges from 0.2% to 2% of all lymphoma cases in the Western world.Among paranasal sinuses, the maxillary sinus is the most common site of involvement, followed by the ethmoid, sphenoid and the frontal sinus.Men are predominantly affected and there is a prevalence of middle to older ages.The most common subtype is diffuse large B-cell lymphoma (DLBCL), comprising approximately two thirds of cases [1].The clinical course of the disease is insidious, as there is either lack of symptoms or just vague, nonspecific symptoms unless the integrity of the sinus wall is breached and local signs of tumor infiltration develop.Symptoms related to tumor extension to nose, orbit or oral cavity include nasal discharge, nasal obstruction, proptosis, diplopia, trismus, headache, regional numbness and teeth loosening [2].In this report, we present a case of DLBCL that developed in the maxillary sinus and presented as a non-tender swelling of the temporal region.A 53-year-old woman presented to her dentist complaining of a nontender tumefaction of the left temporal region and an intermittent mild toothache.She was afebrile and had neither excessive perspiration nor weight loss nor any other kind of systemic B symptoms.The patient mentioned that the swelling had been rapidly increasing within the last ten days, resulting in limited mouth opening.Her medical history was unremarkable except for well-controlled hypertension and knee osteoarthritis; her medications were anti-hypertensives and nonsteroidal anti-inflammatory drugs (NSAIDs).A periapical abscess was suspected, but dental examination, neck palpation, as well as panoramic X-ray failed to disclose any offending tooth or intraoral lesion.Therefore, she was referred for an ENT (ear, nose and throot) consultation.A diagnosis of atypical acute rhinosinusitis was entertained and she was started on a 2-week course of antibiotics.However, the patient did not improve and complained of worsening blurred vision in the left eye and diplopia.Exophthalmos, periorbital and facial edema became clinically apparent within the next 15 days.

Source: Archives of Medical Science

DOI: 10.5114/aoms.2013.34986

Authors: Stergios Doumas, Leonidas Sakkas, Panayiotis Panayiotidis, Greta Wozniak, Marianna Vlychou, George Vassilopoulos