J Rhinol.  2022 Jul;29(2):112-117. 10.18787/jr.2021.00397.

A Case of Primary Diffuse Large B Cell Lymphoma of the Maxillary Sinus Presenting as Epiphora

• Yun YB
• Bae WY
• Kim S
• Park MG

• KMID: 2532014
• DOI: http://doi.org/10.18787/jr.2021.00397

Abstract

Primary sinusoidal non-Hodgkin’s lymphoma (NHL) is a very rare disease. The main symptoms of sinusoidal NHL are rhinorrhea, nasal obstruction, and post-nasal drip. Symptoms such as eye protrusion, diplopia, trismus, and periorbital pain can also occur. Epiphora is a very rare symptom of sinusoidal NHL, which can lead to a misdiagnosis of dacryocystitis or dacryostenosis. The authors report the case of a 46-year-old female patient who visited hospital for symptoms of epiphora, which did not improve even after 3 months of eye treatment, leading to a final diagnosis of maxillary NHL.

Keyword

Diffuse large B-cell lymphoma; Epiphora; Maxillary sinus neoplasm

Figure

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  Fig. 1 Axial view (A) and coronal view (B) of computed tomography showing the peripheral enhancement around non-enhancing low-density lesion (white arrowheads) and dehiscence of right inferior orbit wall and maxillary sinus medial wall (red arrowheads).

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  Fig. 2 Paranasal magnetic resonance imaging (MRI). A: Axial view of T1-weighted MRI shows low signal ovoid lesion at right maxillary sinus bulging to right orbit and right nasal cavity. B: Axial T2-weighted image shows high signal lesion at right maxillary sinus. C: Axial T1- enhanced view shows peripheral rim enhancement (white arrow) around non-enhancing ovoid lesion which bulge to right orbit and right nasal cavity. Thickening and enhancement along right nasolacrimal duct and dehiscence of bony lacrimal canal (white arrowhead) are seen.

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  Fig. 3 Intraoperative endoscopic image showing the yellow mass at right maxillary sinus.

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  Fig. 4 Pathologic findings. A: The large-sized tumor cells with vesicular nuclei showed diffuse growth pattern. Foci of cell necrosis due to rapid tumor growth were observed (hematoxylin-eosin stain, ×400). B: Tumor cells showed strong membranous positive staining for CD20 (CD20, ×400). C: Negative immunoactivity for CD56 (CD56, ×400). D: More than 90% of tumor cells were positive for Ki-67 immunohistochemical staining (Ki-67, ×400).

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  Fig. 5 Radiologic findings of positive emission tomograpy–computed tomograpy. A: At 5 days after operation, hypermetabolic lymphoma in the right inferior orbital wall was observed. B: At 5 months after surgery, infraorbital hypermetabolic tissue disappeared.

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