J Korean Ophthalmol Soc.  2011 Nov;52(11):1351-1356.

A Case of Paranasal Diffuse Large B-Cell Lymphoma with the Orbital Invasion Masquerading as Chronic Sinusitis

• Lee YJ
• Lim JH
• Lew H

Abstract

PURPOSE
To report a case of paranasal diffuse large B-cell lymphoma with orbital invasion extending to the intracranial lesion.
CASE SUMMARY
A 48-year-old male with chronic sinusitis visited our clinic for recent proptosis of his right eye, intermittent pain around the eyeball and headache. On a magnetic resonance image (MRI), a mass-like lesion was observed in the right frontal sinus, and its infiltration into the superior inner portion of the right orbital extraconal space and right intracranial dural space was suggestive of generalized inflammatory mucosal thickening in the paranasal sinuses. An incisional biopsy of the sinonasal tract was immediately performed. The pathology confirmed diffuse large B-cell lymphoma.
CONCLUSIONS
A mass involving the paranasal sinus and orbit can masquerade as chronic sinusitis. Because diffuse large B-cell lymphoma is rare and is a high-grade aggressive malignant lymphoma, the possibility for diagnosis must be considered.

Keyword

Diffuse large B-cell lymphoma; Paranasal sinus

MeSH Terms

B-Lymphocytes
Biopsy
Exophthalmos
Eye
Frontal Sinus
Headache
Humans
Lymphoma
Lymphoma, B-Cell
Magnetic Resonance Spectroscopy
Male
Middle Aged
Orbit
Paranasal Sinuses
Sinusitis

Figure

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  Figure 1. (A, B) The photograph shows the right proptosis and hypoglobus at primary view and extension view. (C) The right-side neck swelling is noted.

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  Figure 2. Contrastenhanced CT scans. (A) Enhancing mass lesion in the right frontal sinus is noted extending to the mass lesion in the superior medial portion of the right orbit extraconal space. (B) Bone destruction (white arrow) adjacent to the mass lesion on image (A) is seen on axial CT scan with bone window setting.

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  Figure 3. Precontrast (A) Gadolinium-enchanced fat saturated T1-weigted MR images (B-D). (A) The mass-like lesion with isointensity to the brain is noted in the superior medial extraconal space of the right orbit (arrow) (B) The MRI image at the same level after contrast shows slightly homogenous enhancement of the mass. (C) Slightly homogenous enhanced mass lesion in the frontal sinus shows focal invasion to the right orbital cavity penetrating the superior ortibal wall. (D) Mild asymmetrical thickening of right rectus muscles, peri-neural enhancement of the right optic nerve (white arrow) and adjacent bone marrow signal change are noted with asymmetrical me-ningeal thickening on the right frontal area (black arrow) as well as genetralized mucosal inflammatory thickening in paranasal sinuses.

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  Figure 4. Pathologic findings of ethmoid sinus mucosa specimen. (A) Microscopically, there are many atypical lymphocytes of uniform, round-to-oval nuclei with vesicular chromatin and one or multiple conspicuous nucleoli, demonstrating non-Hodgkin's lymphoma of the diffuse large B-cell type (H & E, original magnification ×400). (B) Tumor cells are immunopositive for bcl20 (Immunohistochemistry bcl 20 × 200). (C) Immunohistochemical stain reveals that the lymphocytes express CD 20 positivity (Immunohistochemistry CD20 ×200). (D) The immunohistochemical stain for Ki 67 reveals highly proliferative rate of lymphocytes (>90%, Immunohistochemistry Ki 67 ×200).

Reference

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