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

Young Ji Lee; Ji He Lim; Helen Lew

doi:10.3341/jkos.2011.52.11.1351

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Lee, Lim, and Lew: A Case of Paranasal Diffuse Large B-Cell Lymphoma with the Orbital Invasion Masquerading as Chronic Sinusitis

Original Article

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

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.11.1351

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

Young Ji Lee, MD¹, Ji He Lim, MD², Helen Lew, MD, PhD³

¹Department of Opthalmology, The institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea

²Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

³Department of Opthalmology, Bundang CHA Medical Center, CHA University, Seongnam, Korea

Address reprint requests to Helen Lew, MD, PhD Department of Opthalmology, CHA University, Bundang CHA Medical Center #351 Yatap-dong, Bundang-gu, Seongnam 463-712, Korea Tel: 82-31-780-5330, Fax: 82-31-780-5333, E-mail: eye@cha.ac.kr

Received 7 February 2011 Revised 28 April 2011 Accepted 22 September 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Diffuse large B-cell lymphoma, Paranasal sinus

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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.

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.

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.

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).

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