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Eckstein A, Welkoborsky HJ. [Interdisciplinary Management of Orbital Diseases]. Laryngorhinootologie 2024; 103:S43-S99. [PMID: 38697143 DOI: 10.1055/a-2216-8879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
Diagnosis and therapy of orbital diseases is an interdisciplinary challenge, in which i.e. otorhinolaryngologists, ophthalmologists, radiologists, radiation therapists, maxillo-facial surgeons, endocrinologists, and pediatricians are involved. This review article describes frequent diseases which both, otolaryngologists and ophthalmologists are concerned with in interdisciplinary settings. In particular the inflammatory diseases of the orbit including orbital complications, autoimmunological diseases of the orbit including Grave´s orbitopathy, and primary and secondary tumors of the orbit are discussed. Beside describing the clinical characteristics and diagnostic steps the article focusses on the interdisciplinary therapy. The review is completed by the presentation of most important surgical approaches to the orbit, their indications and possible complications. The authors tried to highlight the relevant facts despite the shortness of the text.
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Affiliation(s)
| | - H-J Welkoborsky
- Univ. Klinik für Augenheilkunde Universitätsmedizin Essen, Klinik für HNO-Heilkunde, Kopf- und Halschirurgie, Klinikum Nordstadt der KRH
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2
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Ma W, Hong R, Lou P, Yao M, Wu S, Lin C, Wang C, Chang C, Cheng A, Kuo S. Improved outcomes of localized diffuse large B-cell lymphoma at the Waldeyer ring in comparison to the sinonasal area in the rituximab era. Cancer Med 2023; 13:e6851. [PMID: 38148602 PMCID: PMC10807621 DOI: 10.1002/cam4.6851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 11/28/2023] [Accepted: 12/10/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Diffuse large B-cell lymphoma (DLBCL) of the head-and-neck area primarily involves the Waldeyer ring (WR) and sinonasal area (SN). However, the differential clinical outcomes between patients with WR-DLBCL and those with SN-DLBCL in the rituximab era remain unclear. METHODS To avoid confounding factors contributed by advanced DLBCL with WR and SN involvement, we assessed the clinical outcomes of patients with stage I/II WR-DLBCL and SN-DLBCL and compared them with those having corresponding stages of DLBCL in the lymph nodes but without other extranodal involvement (LN-DLBCL) in the same period. We compared the patients' clinical characteristics, treatment modalities, event-free survival (EFS), and overall survival (OS) among the three subgroups. RESULTS We analyzed 67, 15, and 106 patients with WR-DLBCL, SN-DLBCL, and LN-DLBCL, respectively, between January 2000 and December 2019. All patients received front-line rituximab-based regimens, and > 80% received rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone-based regimens. More patients with SN-DLBCL had revised International Prognostic Index (R-IPI) score 3 (27%) when compared with those with WR-DLBCL (7%) and those with LN-DLBCL (10%, p = 0.181). Patients with WR-DLBCL, LN-DLBCL, and SN-DLBCL had 5-year EFS and OS rates of 80.7%, 59.5%, and 41.9% (p = 0.021) and 83.7%, 70.8%, and 55.8% (p = 0.032), respectively. Compared to patients with LN-DLBCL, those with WR-DLBCL also had a significantly favorable 5-year EFS rate (p = 0.021) and 5-year OS rate (p = 0.023). Three of the 15 patients with SN-DLBCL experienced lymphoma recurrence in the brain after front-line treatment. In multivariate analyses, R-IPI scores of 1-2 and 3 served as significantly poor prognostic factors for patients with poor EFS and OS. CONCLUSIONS Compared to patients with LN-DLBCL, patients with WR-DLBCL receiving front-line rituximab-based treatments had favorable clinical outcomes; however, patients with SN-DLBCL had worse clinical outcomes. Further studies on molecular prognostic factors and treatment strategies for SN-DLBCL are warranted.
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Affiliation(s)
- Wei‐Li Ma
- Department of OncologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
- Cancer Research CenterNational Taiwan University College of MedicineTaipei CityTaiwan
- Graduate Institute of OncologyNational Taiwan University College of MedicineTaipei CityTaiwan
| | - Ruey‐long Hong
- Department of OncologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
- Department of Medical OncologyNational Taiwan University Cancer Center, National Taiwan University College of MedicineTaipei CityTaiwan
| | - Pei‐Jen Lou
- Department of OtolaryngologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
| | - Ming Yao
- Department of Internal MedicineNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
| | - Shang‐Ju Wu
- Department of Internal MedicineNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
| | - Chung‐Wu Lin
- Department of PathologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
- Department of Pathology and Laboratory MedicineKoo Foundation Sun Yat‐Sen Cancer CenterTaipei CityTaiwan
| | - Chun‐Wei Wang
- Department of OncologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
- Cancer Research CenterNational Taiwan University College of MedicineTaipei CityTaiwan
| | - Chin‐Hao Chang
- Department of Medical ResearchNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
| | - Ann‐Lii Cheng
- Department of OncologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
- Graduate Institute of OncologyNational Taiwan University College of MedicineTaipei CityTaiwan
- Department of Medical OncologyNational Taiwan University Cancer Center, National Taiwan University College of MedicineTaipei CityTaiwan
- Department of Internal MedicineNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
| | - Sung‐Hsin Kuo
- Department of OncologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
- Cancer Research CenterNational Taiwan University College of MedicineTaipei CityTaiwan
- Graduate Institute of OncologyNational Taiwan University College of MedicineTaipei CityTaiwan
- Department of Radiation OncologyNational Taiwan University Cancer Center, National Taiwan University College of MedicineTaipei CityTaiwan
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3
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Bitner BF, Htun NN, Wang BY, Brem EA, Kuan EC. Sinonasal lymphoma: A primer for otolaryngologists. Laryngoscope Investig Otolaryngol 2022; 7:1712-1724. [PMID: 36544932 PMCID: PMC9764779 DOI: 10.1002/lio2.941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/28/2022] [Accepted: 09/20/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Sinonasal lymphomas are a rare entity that commonly present with nonspecific sinonasal symptoms and are often recognized immediately. Through this review, we aim to summarize important principles in diagnosis and treatment of sinonasal lymphomas, with the goal of disseminating the current knowledge of this under-recognized malignancy to otolaryngologists. Methods Systemic review using PRISMA guidelines of foundational scholarly articles, guidelines, and trials were reviewed focusing on clinical characteristics of key sinonasal lymphoma subtypes, along with available treatments in the otolaryngology, medical oncology, and radiation oncology literature. Results Sinonasal lymphoma are derived from clonal proliferation of lymphocytes at various stages of differentiation, of which diffuse large B-cell lymphoma (DLBCL) and extranodal natural killer/T-cell lymphoma (ENKTL) are the most common. Diagnosis and staging require biopsy with immunohistochemistry in conjunction with imaging and laboratory studies. Treatment is ever evolving and currently includes multi-agent chemotherapy and/or radiation therapy. Conclusion Otolaryngologists may be the first to recognize sinonasal lymphoma, which requires a comprehensive workup and a multidisciplinary team for treatment. Symptoms are nonspecific and similar to many sinonasal pathologies, and it is crucial for otolaryngologists to keep a broad differential. Level of Evidence 5.
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Affiliation(s)
- Benjamin F. Bitner
- Department of Otolaryngology – Head and Neck SurgeryUniversity of California Irvine Medical CenterOrangeCaliforniaUSA
| | - Nyein Nyein Htun
- Department of Pathology and Laboratory MedicineUniversity of California Irvine Medical CenterOrangeCaliforniaUSA
| | - Beverly Y. Wang
- Department of Pathology and Laboratory MedicineUniversity of California Irvine Medical CenterOrangeCaliforniaUSA
| | - Elizabeth A. Brem
- Department of Medicine, Division of Hematology and OncologyUniversity of California Irvine Medical CenterOrangeCaliforniaUSA
| | - Edward C. Kuan
- Department of Otolaryngology – Head and Neck SurgeryUniversity of California Irvine Medical CenterOrangeCaliforniaUSA,Department of Neurological SurgeryUniversity of California Irvine Medical CenterOrangeCaliforniaUSA
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Eriksen PRG, Clasen-Linde E, Nully Brown PD, Haunstrup L, Christoffersen M, Asdahl P, Thomsen TM, Harwood CD, Heegaard S, Buchwald CV. Sinonasal B-cell lymphomas: A nationwide cohort study, with an emphasis on the prognosis and the recurrence pattern of primary diffuse large B-cell lymphoma. Hematol Oncol 2022; 40:160-171. [PMID: 35104916 PMCID: PMC9303446 DOI: 10.1002/hon.2968] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/04/2022] [Accepted: 01/24/2022] [Indexed: 02/06/2023]
Abstract
Lymphomas of the nasal cavity and paranasal sinuses (NPS) are rare. Knowledge on sinonasal B‐cell lymphoma (SNBCL) primarily comes from case series or single‐center studies on small cohorts. We sought to determine the subtype distribution, clinical characteristics, disease behavior, and prognosis on a nationwide scale, with an emphasis on prognostic factors for the most common sinonasal lymphoma, primary sinonasal diffuse large B‐cell lymphoma (PSDLBCL). We collated all data from medical records and national databases on patients registered with SNBCL from 1980 through 2018 in the national pathology registry and collected all tissue samples for validation of diagnosis. We included 205 patients and found 10 different subtypes of lymphoma. Diffuse large B‐cell lymphoma (DLBCL) was the predominant subtype (80%). The incidence of SNBCL was 0.14/100,000 person‐years. The five‐year progression‐free survival (PFS) and overall survival rates for PSDLBCL were 50% and 56%, respectively. For PSDLBCL, Rituximab showed a statistically significant effect (Hazard Ratio 0.22, p < 0.001), whereas consolidative radiotherapy combined with immunochemotherapy was of limited value (PFS, p = 0.93). When treatment failure occurred, DLBCL showed a distinct pattern of recurrence/dissemination to the NPS, skin, breast, central nervous system (CNS), and/or testis. Collectively, DLBCL comprised a clear majority of SNBCLs, although nine other subtypes were represented. Data showed that immunochemotherapy increased survival for PSDLBCL and that the addition of radiotherapy did not benefit patients. Furthermore, treatment failure for sinonasal DLBCL showed a possible common pathogenesis with primary extranodal lymphomas of specific locations (e.g., CNS, skin, breast, and testis).
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Affiliation(s)
- Patrick R G Eriksen
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Erik Clasen-Linde
- Hematopathology Section, Department of Pathology, Rigshospitalet, Kobenhavn, Denmark
| | - Peter de Nully Brown
- Department of Hematology, Rigshospitalet, University of Copenhagen, Kobenhavn, Denmark
| | - Laura Haunstrup
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Peter Asdahl
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Cecilie Dupont Harwood
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Steffen Heegaard
- Eye Pathology Section, Department of Pathology, Rigshospitalet, University of Copenhagen, Kobenhavn, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark
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5
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Sinai Khandeparkar SG, Bagale P, Pathade S, Gogate B, Battin S. ALK-positive anaplastic large T-cell lymphoma presenting primarily as a sinonasal mass with pseudoproptosis: A case report. Indian J Cancer 2022; 58:592-597. [PMID: 34975099 DOI: 10.4103/ijc.ijc_304_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We report a case of anaplastic lymphoma kinase-positive anaplastic large T-cell lymphoma (ALK+ALCL) presenting primarily as a sinonasal mass with pseudoproptosis in an 11-year-old boy. The diagnosis was based on histopathological and immunohistochemical (IHC) evaluation, which is indispensable for determining tumor type. On the basis of clinicoradiological findings, provisional differential diagnoses of angiofibroma and rhabdomyosarcoma were made. Upon histopathological examination of the biopsy sent, the diagnosis of lymphoma in the sinonasal region was considered. Upon IHC, the tumor cells showed immunoreactivity for vimentin, CD45, CD30, and ALK. The tumor cells showed focal immunoreactivity for CD3 and CD68. Ki-67 labeling index was 70%. They were nonimmunoreactive for PAN cytokeratin, epithelial membrane antigen, cluster of differentiation (CD) 20, CD15, CD56, S100, smooth muscle actin, and myogenin. The diagnosis of ALK+ALCL was rendered. The studied IHC markers confirmed the histopathological diagnosis and helped in further subtyping. To the best of our knowledge, this is the first case of ALCL presenting primarily as a sinonasal mass with pseudoproptosis.
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Affiliation(s)
- Siddhi G Sinai Khandeparkar
- Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Priya Bagale
- Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Smita Pathade
- Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Bageshri Gogate
- Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Shivani Battin
- Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
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Biswas A, Shishak S, Roy S, Kakkar A. Combined Modality Management of Sinonasal Anaplastic Lymphoma Kinase Negative Anaplastic Large Cell Lymphoma in a Geriatric Patient-Report of a Rare Case. Head Neck Pathol 2021; 15:1335-1344. [PMID: 33398683 PMCID: PMC8633218 DOI: 10.1007/s12105-020-01276-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/14/2020] [Indexed: 11/30/2022]
Abstract
Sinonasal anaplastic lymphoma kinase(ALK)-negative anaplastic large cell lymphoma(ALCL) without nodal involvement is exceedingly rare and the rarity of this tumor often engenders diagnostic dilemma. It has been mostly reported in pediatric, adolescent and young adult patients, mostly of Asian origin. A 70-year-old female patient presented with a mass in the left nasal cavity causing nasal obstruction for 5 months. On clinical and radiological examination, there was a 5.7 cm mass in the left nasal cavity, completely obliterating the left ethmoid sinus. Biopsy from the nasal mass showed a poorly differentiated malignant tumour with large cells arranged in sheets. On immunohistochemistry, the tumour cells were positive for leukocyte common antigen(LCA), CD30, CD43, BCL6 and focally for CD5, TIA1, granzyme B and epithelial membrane antigen(EMA), and were negative for CD56, EBV-LMP1, CD79a, PAX5, myeloperoxidase, CD34, CD7, CD4, CD8, CD138, ALK and p63, suggestive of ALK-negative ALCL. Rest of the lymphoma work-up was essentially normal and she had stage IE disease. She was treated with prephase chemotherapy (Vincristine and Prednisolone) followed by 4 cycles of CEOP[Cyclophosphamide, Etoposide (from 2nd cycle onwards), Vincristine and Prednisolone] regimen and local radiotherapy (36 Gy/20 fractions/4 weeks) by intensity modulated radiotherapy(IMRT) technique resulting in complete clinical and radiological response. At last follow-up visit, 15 months from the initial diagnosis, she was alive and disease free. Sinonasal ALK-negative ALCL is a rare tumor which can be effectively treated with a combination of multi-agent CHOP/CHOP-like regimen and local conformal radiotherapy in geriatric patients.
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Affiliation(s)
- Ahitagni Biswas
- Departments of Radiotherapy & Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sorun Shishak
- Departments of Radiotherapy & Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Swarnaditya Roy
- Departments of Radiotherapy & Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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7
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Reginelli A, Urraro F, Sangiovanni A, Russo GM, Russo C, Grassi R, Agostini A, Belfiore MP, Cellina M, Floridi C, Giovagnoni A, Sica A, Cappabianca S. Extranodal Lymphomas: a pictorial review for CT and MRI classification. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:34-42. [PMID: 32945277 PMCID: PMC7944666 DOI: 10.23750/abm.v91i8-s.9971] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/12/2020] [Indexed: 12/12/2022]
Abstract
Extranodal lymphomas represent an extranodal location of both non-Hodgkin and Hodgkin lymphomas. This study aims to evaluate the role of CT and MRI in the assessment of relationships of extranodal lymphomas with surrounding tissues and in the characterization of the lesion. We selected and reviewed ten recent studies among the most recent ones present in literature exclusively about CT and MRI imaging of extranodal lymphomas. Contrast-enhanced computed tomography (CT) is usually the first-line imaging modality in the evaluation of extranodal lymphomas, according to Lugano classification. However, MRI has a crucial role thanks to the superior soft-tissue contrast resolution, particularly in the anatomical region as head and neck. (www.actabiomedica.it)
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Affiliation(s)
- Alfonso Reginelli
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy.
| | - Fabrizio Urraro
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy.
| | - Angelo Sangiovanni
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy.
| | - Gaetano Maria Russo
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy.
| | - Carolina Russo
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy.
| | - Roberta Grassi
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy.
| | - Andrea Agostini
- Radiology Department, Università Politecnica delle Marche, Ancona, Italy.
| | - Maria Paola Belfiore
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy.
| | - Michaela Cellina
- Department of Radiology, Ospedale Fatebenefratelli, ASST Fatebenefratelli Sacco, Milan, Italy.
| | - Chiara Floridi
- Radiology Department, Università Politecnica delle Marche, Ancona, Italy.
| | - Andrea Giovagnoni
- Radiology Department, Università Politecnica delle Marche, Ancona, Italy.
| | - Antonello Sica
- Oncology and Hematology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Salvatore Cappabianca
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy.
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8
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Sakaguchi R, Fujikawa K, Okamoto M, Matsuo E, Matsumoto K, Uchida T, Shin-Ya K, Nakashima M, Mizokami A, Kawakami A. Rheumatoid Arthritis Complicated with Nasal Septum Perforation Due to Methotrexate-associated Lymphoproliferative Disorder. Intern Med 2019; 58:3167-3171. [PMID: 31292392 PMCID: PMC6875446 DOI: 10.2169/internalmedicine.2995-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A 44-year-old female with rheumatoid arthritis treated with methotrexate (MTX) and tocilizumab (TCZ) was admitted to our hospital with nasal pain. Nasal fiberscopy revealed septum perforation, while a membrane biopsy indicated granuloma and fibrinoid necrosis of the small artery. The patient was treated with prednisolone 30 mg/day after discontinuation of MTX and TCZ. Inguinal lymph node biopsy revealed diffuse infiltrations of atypical T-cells and Epstein-Barr virus-positive B cells. The patient was diagnosed with peripheral T-cell lymphoma due to MTX-associated lymphoproliferative disorder (MTX-LPD). We herein describe the case of a patient with nasal septum perforation due to MTX-LPD mimicking granulomatosis with polyangiitis.
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Affiliation(s)
- Ryuki Sakaguchi
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital, Japan
| | - Keita Fujikawa
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital, Japan
| | - Momoko Okamoto
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital, Japan
| | - Emi Matsuo
- Department of Hematology, Japan Community Healthcare Organization, Isahaya General Hospital, Japan
| | - Kohei Matsumoto
- Department of Otolaryngology, Japan Community Healthcare Organization, Isahaya General Hospital, Japan
| | - Tomohisa Uchida
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital, Japan
| | - Kawashiri Shin-Ya
- Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, Japan
| | - Masahiro Nakashima
- Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University, Japan
| | - Akinari Mizokami
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, Japan
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9
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Kewan T, Awada H, Covut F, Haddad A, Daw H. Late Central Nervous System Relapse in a Patient with Maxillary Sinus Lymphoma. Cureus 2018; 10:e3745. [PMID: 30820366 PMCID: PMC6388875 DOI: 10.7759/cureus.3745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Paranasal sinus lymphoma (PNL) is a rare presentation of extranodal non-Hodgkin lymphoma (NHL) with a natural history different from other types of lymphoma. The maxillary sinus is the most common paranasal sinus involved in NHL. Involvement of the central nervous system (CNS) is a rare complication of PNL. In this case report, we present a case of diffuse large B cell lymphoma (DLBL) that developed in the left maxillary sinus and relapsed as a left frontal brain mass after four years of disease remission.
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Affiliation(s)
- Tariq Kewan
- Internal Medicine, Cleveland Clinic - Fairview Hospital, Cleveland, USA
| | - Hassan Awada
- Internal Medicine, Cleveland Clinic - Fairview Hospital, Cleveland, USA
| | - Fahrettin Covut
- Internal Medicine, Cleveland Clinic - Fairview Hospital, Cleveland, USA
| | - Abdo Haddad
- Hematology and Oncology, Cleveland Clinic - Fairview Hospital, Cleveland, USA
| | - Hamed Daw
- Hematology and Oncology, Cleveland Clinic - Fairview Hospital, Cleveland, USA
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10
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Pless D, Keck T, Wiesmiller KM, Lamche R, Aschoff AJ, Lindemann J. Numerical Simulation of Airflow Patterns and Air Temperature Distribution during Inspiration in a Nose Model with Septal Perforation. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240401800603] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The most typical symptoms of patients with nasal septal perforation (SP) are crusting and recurrent nosebleed. The objective of the study was to determine the influence of SP on intranasal temperature profile and airflow patterns during inspiration by means of numerical simulation. Methods Two realistic bilateral models of the human nose with and without SP were reconstructed based on computed tomography (CT). A numerical simulation was performed. The intranasal air temperature distribution and airflow patterns during inspiration were displayed, analyzed, and compared. Results SP causes a highly disturbed airflow in the area of perforation. A spacious vortex within the perforation including various localized vortices was detected. A disturbed intranasal temperature distribution between the right and left nasal cavities developed. Conclusions The numerical simulation demonstrates the interaction between airflow patterns and heating of respiratory air. The disturbed airflow causes reduced air conditioning. This fact may contribute to crusting and recurrent nosebleed.
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Affiliation(s)
- Daniela Pless
- Departments of Diagnostic Radiology, University of Ulm, Ulm, Germany
| | - Tilman Keck
- Departments of Otorhinolaryngology, University of Ulm, Ulm, Germany
| | | | - Ralf Lamche
- Departments of Thoracic and Vascular Surgery, University of Ulm, Ulm, Germany
| | - Andrik J. Aschoff
- Departments of Diagnostic Radiology, University of Ulm, Ulm, Germany
| | - Joerg Lindemann
- Departments of Otorhinolaryngology, University of Ulm, Ulm, Germany
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Shirazi N, Bist SS, Puri N, Harsh M, Ahmad S. Primary sinonasal lymphoma in immunocompetent patients: A 10 years retrospective clinicopathological study. J Oral Maxillofac Pathol 2018; 22:280-281. [PMID: 30158788 PMCID: PMC6097383 DOI: 10.4103/jomfp.jomfp_45_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Introduction: Sinonasal tumors occur in the nasal cavity or paranasal sinuses (PNS). These tumors are rare and lymphomas are even rarer. Lymphoma of the nose and PNS may mimic benign processes and may manifest either in an isolated fashion or in conjunction with systemic diseases. B-cell lymphomas, a more favorable diagnosis, account for the majority of cases, whereas T-cell and extranodal natural killer lymphoma are associated with rapid disease progression and death. Materials and Methods: All patients with sinonasal lymphomas who were nonreactive for HIV and were operated and treated in our hospital from 2006 to 2016 were included in the study. Histopathological diagnosis and immunohistochemistry using a panel of antibodies (CK, CD99, CD 15, CD30, CD45, Bcl 2, anaplastic lymphoma kinase-1, CD 16, CD 57 and ki-67) were reviewed and recorded. Results: Out of 153 malignant sinonasal tumors, 18 were diagnosed with lymphoma. Non-Hodgkins lymphoma constituted 88.8% of cases with the most common subtype being diffuse large B-cell lymphoma (n = 12, 66.6%). Maxillary sinus was the most frequently involved site (62%). The average age of presentation was 52 years with a slight male predominance. Computed tomography and magnetic resonance imaging scans were done in virtually all cases to assess the extent of the tumor as well as bony destruction. Average 5-year survival was 50%. Local recurrence was the most frequent cause of treatment failure. Conclusion: Malignant lymphomas constituted 11.7% of all malignancies of PNS. The association of diffuse large B-cell tumors with obstructive nasal mass and T-cell tumors with septal perforation, orbital extension and ophthalmological symptoms were more commonly seen.
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Affiliation(s)
- Nadia Shirazi
- Department of Pathology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Sampan Singh Bist
- Department of Ear Nose and Throat, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Neeti Puri
- Department of Pathology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Meena Harsh
- Department of Pathology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Sohaib Ahmad
- Department of General Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
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Steele TO, Buniel MC, Mace JC, El Rassi E, Smith TL. Lymphoma of the nasal cavity and paranasal sinuses: A case series. Am J Rhinol Allergy 2017; 30:335-9. [PMID: 27657899 DOI: 10.2500/ajra.2016.30.4347] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Lymphomas of the sinonasal tract are a rare and heterogeneous subset of solid sinonasal neoplasms. OBJECTIVE To characterize, in this case series, presenting symptoms, treatment modalities, and outcomes for patients with sinonasal lymphoma within a single institution. METHODS Retrospective patient data were collected from an academic, oncologic center and entered into a repository designed to capture outcomes for sinonasal malignancies. Patient demographics, presenting symptoms, imaging findings, treatment modalities, and health status were retrospectively extrapolated and evaluated by using Kaplan-Meier estimations for survival probability. RESULTS Patients with sinonasal lymphoma with a mean follow-up of 50 months were identified (n = 18). Histologic diagnosis included the following: diffuse large B-cell lymphoma (n = 9), natural killer/T-cell lymphoma (n = 5), follicular lymphoma (n = 1), T-cell lymphoma (n = 1), and lymphoma-not otherwise specified (n = 2). The most frequent presenting symptoms were nasal obstruction (78%), facial pain (72%), facial swelling (50%), and nasal discharge (44%). Treatment before lymphoma diagnosis included antibiotics (83%), oral steroids (22%), decongestants (22%), and topical steroids (11%). Treatment regimens after diagnosis included both chemotherapy (94%) and chemoradiotherapy (56%). Survival rates by lymphoma subtype were 56% for B-cell lymphoma and 40% for natural killer/T-cell lymphoma. Overall, 2- and 5-year survival rates were 67% and 50%, respectively. The combination of chemotherapy and radiation resulted in significantly higher survival rates (p ≤ 0.001) than chemotherapy alone. CONCLUSION Sinonasal lymphomas are characterized by meager survival rates, which differ by histopathologic subtype. The diagnosis of sinonasal lymphoma is challenging because symptoms frequently parallel those of chronic rhinosinusitis. Increased awareness of these rare malignancies may improve detection and more timely treatment. Clinical trial registration NCT01332136.
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Affiliation(s)
- Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, USA
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13
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Gibson TN, McNaughton DP, Hanchard B. Sinonasal malignancies: incidence and histological distribution in Jamaica, 1973–2007. Cancer Causes Control 2017. [DOI: 10.1007/s10552-017-0916-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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14
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Kuan EC, Tajudeen BA, Bhuta SM, Palma Diaz MF, Kedeshian PA, Suh JD. Incidental finding of lymphoma after septoplasty. ALLERGY & RHINOLOGY 2016; 7:90-5. [PMID: 27470206 PMCID: PMC5010439 DOI: 10.2500/ar.2016.7.0153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction: Septoplasty, or surgical correction of the deviated septum, is an elective, routinely performed rhinologic procedure to address nasal airway obstruction. In many cases, resected septal cartilage and bone fragments are sent for pathologic review, although there is no consensus on this practice. We reported two cases of incidentally diagnosed lymphoma after elective septoplasty and discussed clinical presentation, diagnosis, and management. Methods: Retrospective chart review of two patients who underwent septoplasty at a tertiary academic medical center and found to have incidental lymphoma based on histopathology. Results: Two patients who underwent septoplasty had an incidental diagnosis of lymphoma on pathologic analysis. One patient was noted to have an S-shaped septal deviation that produced bilateral nasal obstruction. She underwent a difficult septoplasty, in which the mucoperichondrial flap was firmly adherent to the underlying septum and bone. Final pathology demonstrated diffuse large B-cell lymphoma. She was treated with chemoradiation and remained free of disease at 59 months. The other patient had a history of nasal trauma, which produced left septal deviation. He underwent an uncomplicated septoplasty, with pathology that demonstrated low-grade B-cell lymphoma. Because there was no evidence of active disease, the decision was made to not treat and to observe the patient clinically. Conclusions: This is the first reported series of septal lymphoma incidentally diagnosed on routine septoplasty. Although histopathologic review of specimens from routine nasal and sinus surgery is not routinely performed, this report highlighted the importance of this process, on a case-by-case basis, in detecting unexpected malignancies that otherwise were clinically silent.
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Affiliation(s)
- Edward C Kuan
- Department of Head and Neck Surgery, University of California, Los Angeles (UCLA), Los Angeles, California, USA
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15
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Ye H, Gong Z, Yang W, Dai Y. Primary non-Hodgkin lymphoma of the sphenoid sinus with visual disturbance: A report of two cases. Oncol Lett 2016; 11:4252-4254. [PMID: 27313774 DOI: 10.3892/ol.2016.4534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 03/08/2016] [Indexed: 12/30/2022] Open
Abstract
Primary non-Hodgkin lymphoma (PNHL) of the sphenoid sinus is a rare neoplasm that poses a diagnostic challenge to clinicians. The proximity of the optical nerve and canal to the sphenoid sinus is accountable for the high incidence of visual disturbance in PNHL of the sphenoid sinus. In particular, patients whose radiologic diagnosis reveals bone destruction in the lateral wall involved with optical-nerve-canals or cavernous sinus present a high risk of rapidly developing unilateral blindness. The present study reports 2 rare cases of PNHL of the sphenoid sinus. Sudden sight loss may follow minimally invasive biopsy. In such cases, the measures that must be taken for the prevention of permanent sight loss are limited in the absence of the final pathologic diagnosis.
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Affiliation(s)
- Huiping Ye
- Department of Otolaryngology, Head and Neck Surgery, The Affiliated Baiyun Hospital of Guizhou Medical University, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China; Department of Pathology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China
| | - Zhengpeng Gong
- Department of Otolaryngology, Head and Neck Surgery, The Affiliated Baiyun Hospital of Guizhou Medical University, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China
| | - Wen Yang
- Department of Pathology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China
| | - Yubing Dai
- Department of Otolaryngology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
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Clinical findings of extranodal SNT lymphoid malignancies in a four-decade single-centre series. Eur Arch Otorhinolaryngol 2016; 273:3839-3845. [PMID: 27010643 DOI: 10.1007/s00405-016-3992-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 03/15/2016] [Indexed: 01/01/2023]
Abstract
Sinonasally located lymphoid malignancies are rare lesions with first symptoms similar to other obstructive conditions. Additionally, they often coexist with nasal inflammation and mucosal necrosis. Therefore, time from the first symptoms to diagnosis tends to be long. Awareness and early diagnosis of this disease entity could improve treatment outcome. Altogether, 142 patients with sinonasal or nasopharyngeal (i.e. sinonasal tract, SNT) lymphoid malignancies, diagnosed and treated at the Helsinki University Hospital, during a 39-year period from 1975 to 2013, were retrospectively reviewed. There were 90 males (63 %) and 52 females (37 %) with a median age of 64 years (range 26-92). Eighty-four percent of the patients had primary diseases and 16 % had relapses of lymphoid malignancies primarily diagnosed at other locations. The mean duration of symptoms prior to diagnosis was 4.8 months (range 0.5-24). The most common histological entity was diffuse large B-cell lymphoma (43 %), followed by plasmacytoma (18 %). The most common location was nasopharynx (58 %) followed by nasal cavity (44 %) and paranasal sinuses (35 %). Sixty-nine percent of the lesions were at a single anatomic location of the sinonasal tract. Fifty-two percent of the cases were of Ann Arbor Stage I. Lymphoid malignancies form an important and diverse group in the differential diagnosis of SNT tumours. They most often present with general obstructive nasal symptoms due to tumour location. Most of them are primary lesions, highlighting the importance of an accurate diagnosis as early as possible.
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Miyagi Maeshima A, Taniguchi H, Makita S, Kitahara H, Miyamoto K, Fukuhara S, Munakata W, Suzuki T, Maruyama D, Kobayashi Y, Tobinai K. Histopathological Characteristics of Lymphomas in the Upper Aerodigestive Tract. A Single-Institute Study in Japan. J Clin Exp Hematop 2016; 55:7-11. [PMID: 26106000 DOI: 10.3960/jslrt.55.7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
We analyzed the histopathological characteristics of lymphomas biopsied from the upper aerodigestive tract between 2000 and 2014 at the National Cancer Center Hospital in Japan. Of a total of 309 consecutive cases, the following incidences were observed: mature B-cell neoplasms, 77% (n = 239); mature T- and NK-cell neoplasms, 20% (n = 63); classical Hodgkin lymphomas, 0.7% (n = 2); and lymphoblastic lymphomas, 2% (n = 5). Lymphomas were most frequently (57%) detected in the oropharynx. The majority of cases (89%) were mature B-cell neoplasms (diffuse large B-cell lymphoma, 60%; follicular lymphoma, 10%), and 10% of cases were mature T-cell neoplasms. Six cases of plasma cell neoplasm (4 primary and 2 secondary involvement) and 2 cases of plasmablastic lymphoma in the upper aerodigestive tract were observed. Two out of 3 cases of extraosseous plasmacytoma with available biopsy material were positive for EBER1. All 3 patients received irradiation and achieved complete response; 1 had not relapsed after 17 months and the remaining 2 relapsed as plasma cell myeloma and solitary plasmacytoma of the bone. Of 47 extranodal NK/T-cell lymphoma, nasal-type cases in the upper aerodigestive tract, 38 (81%) were present in the sinonasal region and the remaining 9 (19%) were in the oropharynx (n = 4), nasopharynx (n = 3), and oral cavity (n = 2). In conclusion, since both primary lymphoma and secondary involvement of lymphoma are often diagnosed using biopsied materials from the upper aerodigestive tract, pathologists and hematologists should recognize the characteristics of lymphoma in this tissue.
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Abstract
The nasal cavity and paranasal sinuses occupy the top of the upper respiratory tract and form pneumatic spaces connected with the atmosphere. They are located immediately beneath the base of the cranium, where crucial vital structures are harbored. From this region, very much exposed to airborne agents, arise some of the more complex and rare benign and malignant lesions seen in humans, whose difficulties in interpretation make this remarkable territory one of the most challenging in the practice of surgical pathology. Contents of this chapter cover inflammations and infections, polyps and pseudotumors, fungal and midfacial destructive granulomatous lesions, as well as benign, borderline, and malignant neoplasms. Among the neoplasms, emphasis is made on those entities characteristic or even unique for the sinonasal region, such as Schneiderian papillomas, glomangiopericytoma, intestinal- and non-intestinal-type adenocarcinomas, olfactory neuroblastoma, nasal-type NK-/T-cell lymphoma, and teratocarcinosarcoma. Moreover, recently recognized entities involving this territory, i.e., HPV-related non-keratinizing carcinoma, NUT carcinoma, and SMARCB1-deficient basaloid carcinoma, are also discussed in the light of their specific molecular findings. Furthermore, the text is accompanied by numerous classical and recent references, several tables, and 100 illustrations.
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Affiliation(s)
- Antonio Cardesa
- University of Barcelona, Anatomic Pathology Hospital Clínic University of Barcelona, Barcelona, Spain
| | - Pieter J. Slootweg
- Radboud Univ Nijmegen Medical Center, Pathology Radboud Univ Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Nina Gale
- University of Ljubljana,, Institute of Pathology, Faculty of Medic University of Ljubljana,, Ljublijana, Slovenia
| | - Alessandro Franchi
- University of Florence, Dept of Surg & Translational Medicine University of Florence, Florence, Italy
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19
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Abstract
Extranodal NK/T-cell lymphoma, nasal type (ENKL) is a rare lymphoid neoplasm that in the past has been grouped with a variety of granulomatous diseases. ENKL occurs in all age groups. However, it seems to occur more often in people in their 50s and affects more men than women. It is strongly linked to the Epstein-Barr virus (EBV), especially in people of Asian countries. Because this type of lymphoma occurs in organs or tissues other than lymph nodes, it is called ENKL. This is a case report of a 25-year-old female patient who presented with a nonhealing ulcer at the right nasal ala involving the upper lip and cheek for the last 2 months, which had been treated with antitubercular treatment without success. After biopsy and immunohistochemical (IHC) analysis, the patient had been diagnosed a case of extranodal T-cell lymphoma.
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Affiliation(s)
- Seema Devi
- Department of Radiation Oncology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Richi Sinha
- Department of Otolaryngology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Rakesh Kumar Singh
- Department of Otolaryngology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Gagan Mehta
- Department of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
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20
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Orbital presentation of a nasal midline destructive lesion in a young boy. Ophthalmic Plast Reconstr Surg 2015; 31:e40-3. [PMID: 24797418 DOI: 10.1097/iop.0000000000000063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Midline Destructive Lesions (MDL) are well known to cause nasal problems. There is a long differential diagnosis of such lesions. However, in the pediatric population, the 2 main diseases to be aware of are Non-Hodgkin's T-cell lymphoma and granulomatosis with polyangiitis (previously known as Wegener's granulomatosis). The authors present the report of a 15-year-old boy who presented with epiphora, chemosis, and limitation of left abduction. CT scan of his orbits suggested a destructive lesion of the ethmoid sinuses. His laboratory investigations revealed a positive ANCA. The patient underwent endoscopic sinus surgery, and this was characteristic for granulomatosis with polyangiitis. He was treated with systemic steroids and then maintained on cyclophosphamide, which controlled his disease activity. This case highlights the need for ophthalmologists to have a high index of suspicion for MDL and concomitant orbital disease.
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21
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Abstract
Various hematolymphoid lesions involve the sinonasal tract, including aggressive B, T, and NK-cell neoplasms; myeloid sarcoma; low-grade lymphomas; indolent T-lymphoblastic proliferations; and Rosai-Dorfman disease. Differentiating aggressive lymphomas from non-hematopoietic neoplasms such as poorly differentiated squamous cell carcinoma, olfactory neuroblastoma, or sinonasal undifferentiated carcinoma may pose diagnostic challenges. In addition, the necrosis, vascular damage, and inflammatory infiltrates that are associated with some hematolymphoid disorders can result in misdiagnosis as infectious, autoimmune, or inflammatory conditions. Here, we review hematolymphoid disorders involving the sinonasal tract including their key clinical and histopathologic features.
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Affiliation(s)
- Genevieve M Crane
- Department of Pathology, The Johns Hopkins Medical Institutions, Weinberg 2242, 401 N Broadway, Baltimore, Maryland 21231-2410
| | - Amy S Duffield
- Department of Pathology, The Johns Hopkins Medical Institutions, Weinberg 2242, 401 N Broadway, Baltimore, Maryland 21231-2410.
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22
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Lombard M, Michel G, Rives P, Moreau A, Espitalier F, Malard O. Extranodal non-Hodgkin lymphoma of the sinonasal cavities: A 22-case report. Eur Ann Otorhinolaryngol Head Neck Dis 2015; 132:271-4. [PMID: 26363601 DOI: 10.1016/j.anorl.2015.08.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To determine presenting features, management and prognosis in extranodal non-Hodgkin lymphoma of the sinonasal tract. MATERIAL AND METHODS A retrospective study between 2004 and 2013 in the University Hospital Center of Nantes (France) recruited patients with lymphoma discovered by sinonasal involvement. Epidemiologic, diagnostic, clinical and prognostic criteria were analyzed, with survival studied on the Kaplan-Meier estimator and Log-rank test. RESULTS Twenty-two patients were included: 14 male, 7 female, with a mean age of 65 years at diagnosis. All had non-Hodgkin lymphoma, with strong predominance of diffuse large B-cell lymphoma (77%). Seven patients had risk factors for lymphoma (infection by HIV, EBV or chronic lymphocytic leukemia). A majority (68%) had advanced tumor at diagnosis (stage IV on the Ann Arbor classification). Most were located in the craniofacial bones (68%), mainly involving the maxillary or ethmoidal sinuses. The most frequent presenting symptoms were unilateral nasal obstruction, mucopurulent rhinorrhea, recurrent epistaxis or diplopia. Treatment consisted in chemotherapy, in some cases associated to radiotherapy. Overall survival was 82% at 12 months and 73% at 36 months. Recurrence-free survival was 76% at 12 months and 64% at 36 months. CONCLUSION Lymphoma is an aggressive pathology; revelation by sinonasal involvement is rare. Recommended treatment is chemotherapy, possibly associated to radiotherapy. Prognosis depends on histologic type, Ann Arbor stage at diagnosis and the therapeutic options available for the individual patient.
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Affiliation(s)
- M Lombard
- Service d'ORL et de chirurgie cervico-faciale, centre hospitalier universitaire de Nantes, Hôtel-Dieu, 1, place A.-Ricordeau, BP 1005, 44093 Nantes cedex 01, France
| | - G Michel
- Service d'ORL et de chirurgie cervico-faciale, centre hospitalier universitaire de Nantes, Hôtel-Dieu, 1, place A.-Ricordeau, BP 1005, 44093 Nantes cedex 01, France
| | - P Rives
- Service d'ORL et de chirurgie cervico-faciale, centre hospitalier universitaire de Nantes, Hôtel-Dieu, 1, place A.-Ricordeau, BP 1005, 44093 Nantes cedex 01, France
| | - A Moreau
- Service d'anatomopathologie, centre hospitalier universitaire de Nantes, Hôtel-Dieu, 1, place A.-Ricordeau, BP 1005, 44093 Nantes cedex 01, France
| | - F Espitalier
- Service d'ORL et de chirurgie cervico-faciale, centre hospitalier universitaire de Nantes, Hôtel-Dieu, 1, place A.-Ricordeau, BP 1005, 44093 Nantes cedex 01, France
| | - O Malard
- Service d'ORL et de chirurgie cervico-faciale, centre hospitalier universitaire de Nantes, Hôtel-Dieu, 1, place A.-Ricordeau, BP 1005, 44093 Nantes cedex 01, France.
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Kato H, Kanematsu M, Watanabe H, Kawaguchi S, Mizuta K, Aoki M. Differentiation of extranodal non-Hodgkins lymphoma from squamous cell carcinoma of the maxillary sinus: a multimodality imaging approach. SPRINGERPLUS 2015; 4:228. [PMID: 26120502 PMCID: PMC4478190 DOI: 10.1186/s40064-015-0974-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 04/09/2015] [Indexed: 01/13/2023]
Abstract
This study aimed to assess the efficacy of a multimodality imaging approach for differentiating between primary extranodal non-Hodgkin’s lymphoma (NHL) and squamous cell carcinoma (SCC) of the maxillary sinus. Twelve NHLs and 29 SCCs of the maxillary sinus were included. CT findings, MR signal intensities, apparent diffusion coefficients (ADCs), and maximum standardized uptake values (SUVmax) were correlated with two pathologies. On CT, permeative growth frequency was greater among NHLs than among SCCs (50 % vs. 10 %; p < 0.01), whereas destructive growth frequency was greater among SCCs than among NHLs (83 % vs. 33 %; p < 0.01). On CT, remaining sinus wall within the tumor was more frequent with NHLs than with SCCs (92 % vs. 34 %; p < 0.01), whereas intratumoral necrosis was more frequent with SCCs than with NHLs (86 % vs. 17 %; p < 0.01). ADCs were lower for NHLs than for SCCs (0.61 vs. 0.95 × 10–3 mm2/s; p < 0.01). No significant differences in MR signal intensities and SUVmax were observed. Tumor growth pattern, remaining sinus wall within the tumor, and intratumoral necrosis were useful CT findings for differentiating between NHLs and SCCs. ADC measurements could assist the differentiation of NHL from SCC.
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Affiliation(s)
- Hiroki Kato
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Masayuki Kanematsu
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan ; High-level Imaging Diagnosis Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Haruo Watanabe
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan
| | | | - Keisuke Mizuta
- Department of Otolaryngology, Gifu University School of Medicine, Gifu, Japan
| | - Mitsuhiro Aoki
- Department of Otolaryngology, Gifu University School of Medicine, Gifu, Japan
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Yoshihara S, Kondo K, Ochi A. Diffuse large B-cell lymphoma in the sphenoid sinus mimicking fibrous dysplasia in CT and MRI. BMJ Case Rep 2014; 2014:bcr-2014-205272. [PMID: 25100815 DOI: 10.1136/bcr-2014-205272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present a 70-year-old man with lymphoma who presented with a right eye movement disorder. CT examinations showed 'ground-glass' appearance extending around the right sphenoid sinus which suggested fibrous dysplasia. However, biopsy from the mass histologically proved it to be diffusing large B-cell lymphoma and positron emission tomography examinations revealed increased fluorodeoxyglucose (FDG) uptake around the right sphenoid bone and multiple spinal bones. After chemotherapy for lymphoma, abnormal FDG uptake disappeared from the body.
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25
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Peng KA, Kita AE, Suh JD, Bhuta SM, Wang MB. Sinonasal lymphoma: case series and review of the literature. Int Forum Allergy Rhinol 2014; 4:670-4. [PMID: 24760602 DOI: 10.1002/alr.21337] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 03/06/2014] [Accepted: 03/23/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND Sinonasal lymphoma is a rare rhinologic entity. We present a case series and review the literature surrounding the diagnosis and management of this disease. METHODS A pathology database spanning 22 years at a tertiary care center was searched for a diagnosis of lymphoma in the paranasal sinuses or the nasal cavity. Seventeen cases were identified, and retrospective chart review was performed. RESULTS Maxillary and ethmoid sinuses were affected more frequently (n = 8 patients each) than sphenoid and frontal sinuses (n = 5 patients each). Histologically, the most common type was diffuse large B-cell lymphoma (53%, 9 patients), followed by extranodal natural killer/T-cell lymphoma (ENKL, 21%, 3 patients). Presenting symptoms included nasal obstruction and rhinorrhea (53%, 9 patients) and diplopia (18%, 3 patients); and radiographic imaging demonstrated a discrete mass (59%, 10 patients), sinus opacification (53%, 9 patients), and/or bony erosion (35%, 6 patients). Treatment included chemotherapy alone (71%, 12 patients), chemotherapy and radiation (6%, 1 patient), and radiation alone (6%, 1 patient). The 2-year and 5-year overall survival rates were 75% and 53%, respectively, whereas disease-free 2-year and 5-year survival rates were 70% and 49%, respectively. CONCLUSION Lymphoma of the nasal cavity and paranasal sinuses is extremely rare, may mimic benign processes, and may manifest either in an isolated fashion or in conjunction with systemic disease. B-cell lymphomas, a more favorable diagnosis, account for a majority of cases, whereas ENKL is associated with rapid disease progression and death. Chemotherapy and radiation are the main therapies. Histologic diagnosis is of paramount importance, and clinicians must remain cognizant of this entity to differentiate it from other sinonasal malignancies.
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Affiliation(s)
- Kevin A Peng
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
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26
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Diffuse large B-cell lymphoma of the sinonasal tract: analysis of survival in 852 cases. Am J Otolaryngol 2014; 35:154-8. [PMID: 24209993 DOI: 10.1016/j.amjoto.2013.09.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 09/20/2013] [Indexed: 11/22/2022]
Abstract
PURPOSE Diffuse large B-cell lymphomas (DLBCLs) are rare tumors of the head and neck that often have non-specific presentations and significant morbidity and mortality. In this analysis we use a large cohort to compare the demographic and disease-specific parameters affecting survival and incidence of DLBCLs. METHODS The United States National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry was utilized to extract data regarding sinonasal diffuse large B-cell lymphoma between 1973 and 2009. A total of 852 cases of sinonasal DLBCLs were found. Presenting symptoms, demographics, disease specific survival, relative survival and survival by treatment modality were described for this rare tumor. RESULTS Overall disease specific survival (DSS) at 1-year was 84.7% and at 5 years was 68.0%. DSS was significantly lower for those not treated with radiation therapy, with 1- and 5-year survival rates of 77.3% and 62.5%, versus those treated with radiation therapy, with 1- and 5-year rates of 89.2% and 71.5% (p<0.05). Prognosis was significantly better for patients treated with radiation therapy (HR 0.6, p<0.05) while it was poorer for patients with involvement of multiple sinuses (HR 1.5, 1.8, p<0.05). CONCLUSIONS DLBCLs of the sinonasal tract are rare tumors of the head and neck. Survival is significantly improved for those treated with radiation therapy while the involvement of multiple sinuses is a negative prognostic indicator.
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27
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Szewczyk-Bieda MJ, White RD, Budak MJ, Ananthakrishnan G, Brunton JN, Sudarshan TA. A whiff of trouble: tumours of the nasal cavity and their mimics. Clin Radiol 2014; 69:519-28. [PMID: 24525221 DOI: 10.1016/j.crad.2013.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 12/06/2013] [Accepted: 12/10/2013] [Indexed: 12/28/2022]
Abstract
A range of disease entities can affect the nasal cavity, often presenting with variable and non-specific symptoms. There is considerable overlap between the clinical and radiological features of neoplastic and non-neoplastic entities. The nasal cavity is often included in routine imaging of the brain, middle ear, skull base, and paranasal sinuses and should be included as a critical review area. The definitive diagnosis is in most cases confirmed by histopathological analysis. However, this review highlights the role of imaging in identifying nasal cavity disease, eliciting features of aggressive or indolent behaviour, and helping to narrow the differential diagnosis, thus facilitating a systematic approach when reviewing the nasal cavity.
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Affiliation(s)
- M J Szewczyk-Bieda
- Clinical Radiology Department, Ninewells Hospital and Medical School, Dundee, UK.
| | - R D White
- Clinical Radiology Department, Ninewells Hospital and Medical School, Dundee, UK; Department of Clinical Radiology, University Hospital of Wales, Cardiff, UK
| | - M J Budak
- Clinical Radiology Department, Ninewells Hospital and Medical School, Dundee, UK
| | - G Ananthakrishnan
- Clinical Radiology Department, Ninewells Hospital and Medical School, Dundee, UK; Department of Clinical Radiology, Manchester Royal Infirmary Hospital, Manchester, UK
| | - J N Brunton
- Clinical Radiology Department, Ninewells Hospital and Medical School, Dundee, UK
| | - T A Sudarshan
- Clinical Radiology Department, Ninewells Hospital and Medical School, Dundee, UK
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28
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Walker R, Heffelfinger R. Low-grade B-cell lymphoma presenting as a uvular mass. EAR, NOSE & THROAT JOURNAL 2013; 91:E22-4. [PMID: 23288827 DOI: 10.1177/014556131209101218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Uvular enlargement may occur acutely as a result of infection, allergy, or trauma. Squamous cell carcinoma may present as a progressively enlarging uvular mass. Primary MALT (mucosa-associated lymphoid tissue) lymphoma of the uvula and a neuroendocrine tumor of the parapharyngeal space presenting as a uvular mass have each been previously described in the literature. Here we present a case of low-grade B-cell lymphoma presenting as a uvular mass in a 55-year-old patient with progressive throat swelling and dysphagia.
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Affiliation(s)
- Ryan Walker
- Department of Otolaryngology-Head and Neck Surgery, University of Rochester Medical Center, Rochester, NY 14642, USA.
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Unilateral non-Hodgkin's lymphoma of the frontal sinus presenting as Pott's puffy tumour. Otolaryngol Pol 2013; 67:214-7. [DOI: 10.1016/j.otpol.2012.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 11/28/2012] [Indexed: 11/19/2022]
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Kumar M, Kumar A, Goel MM. Extranodal T-cell lymphoma of nasal cavity. Indian J Hematol Blood Transfus 2013; 29:87-9. [PMID: 24426344 PMCID: PMC3636360 DOI: 10.1007/s12288-011-0141-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 12/26/2011] [Indexed: 11/26/2022] Open
Abstract
A rare case of primary extranodal lymphoma of nasal cavity is here with reported in a 11 years old female child. Patient presented with space occupying extensive lesion in nasal cavity with destraction of nasal septum and obliteration of paranasal sinuses. After histological examination and routine stain showed a round cell tumor with provisional diagnosis of large cell non-Hodgkin's lymphoma was made. Immunohistochemical stain were used to further differentiate from other possibilities mimics as carcinoma and round cell tumors. Immunohistochemical stain confirm the diagnosis of extranodal T-cell lymphoma. We report this case for its rarity in paediatric patients.
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Affiliation(s)
- Madhu Kumar
- Department of Pathology, C.S.M. Medical University, Lucknow, India
| | - Ashutosh Kumar
- Department of Pathology, C.S.M. Medical University, Lucknow, India
| | - Madhu Mati Goel
- Department of Pathology, C.S.M. Medical University, Lucknow, India
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Sandner A, Surov A, Bach AG, Kösling S. Primary extranodal Non-Hodgkin lymphoma of the orbital and paranasal region-a retrospective study. Eur J Radiol 2012; 82:302-8. [PMID: 23092540 DOI: 10.1016/j.ejrad.2012.03.036] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 03/11/2012] [Accepted: 03/12/2012] [Indexed: 11/16/2022]
Abstract
PURPOSE Primary extranodal lymphomas of the orbit and sinonasal region are rare and occur almost only as Non-Hodgkin lymphoma (NHL). The purpose of this study was to determine the frequency of different subtypes of NHL in these regions and to describe their radiological features. MATERIALS AND METHODS Between January 2005 and January 2010, 567 patients with malignant immunoproliferative diseases (MID) were treated at our institution. Primary sinonasal and orbital manifestation was diagnosed in 36 cases. There were 13 women and 23 men with a median age of 67 years. CT and MRI were performed in 14 and 24 patients, respectively. Imaging was re-interpretated and histological subtypes were listed. RESULTS Among all MID primary sinonasal and orbital NHL occurred with a frequency of 6%. Diffuse large cell lymphoma was identified in 11 cases (30%), marginal cell lymphoma in 6 (16%), and extranodal plasmacytoma in 5 (14%). Other subtypes were rare. On CT, lesions of soft tissue attenuation with homogeneous moderate contrast enhancement were seen in all cases. On T2-weighted fat saturated images 52% of the lesions were slightly hyperintense in comparison to unaffected musculature, 41% were isointense, and 7% slightly hypointense. On T1-weighted sequences most lesions (81%) were homogeneously isointense. After contrast administration marked enhancement was seen in 41%, moderate in 52%, and slight enhancement in 7%. CONCLUSION The identified radiological features should be included in the differential analysis of lesions in the orbital and sinonasal regions, but they are not specific enough. For exact therapeutic planning histopathological diagnosis of the subtype is required.
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Affiliation(s)
- Annett Sandner
- Department of Otorhinolaryngology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06097 Halle, Germany.
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Shetty D, Aroor R, Somayaji KSG, Tahir M, Mohammad NA. Sinonasal T cell lymphoma: a case report. Indian J Otolaryngol Head Neck Surg 2012; 63:16-8. [PMID: 22754825 DOI: 10.1007/s12070-011-0172-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2008] [Accepted: 08/15/2008] [Indexed: 11/27/2022] Open
Abstract
Sinonasal lymphomas are aggressive locally destructive midfacial necrotizing lesions. Most of them initially diagnosed as lethal midline granulomas, a term which is slowly replaced by sinonasal lymphoma. Here is one such case report of sinonasal T cell lymphoma where there was a difficulty in diagnosis and required an incisional biopsy.
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The diagnosis of sinonasal lymphoma: a challenge for rhinologists. Eur Arch Otorhinolaryngol 2011; 269:1463-9. [DOI: 10.1007/s00405-011-1839-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 11/08/2011] [Indexed: 12/26/2022]
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Abstract
Non-Hodgkin lymphomas (NHLs) are a heterogenic group of lymphoproliferative diseases with their different behavior pattern and response to treatments. As a Hodgkin disease, NHL occurs from lymphoid tissues and can spread to other organs. Prognosis depends on histologic type, grade, and treatment. In the World Health Organization classification, aggressive B-cell lymphomas are diffuse large B-cell lymphoma, Burkitt lymphoma/leukemia, and precursor lymphoblastic leukemia/lymphoma. They may present either nodal or extranodal disease, which may be either localized or disseminated. Diffuse large B-cell lymphoma is the most common type of lymphoma in adults and is clinically, morphologically, and genetically a heterogeneous group of malignant proliferations of mature B cells, too. Diffuse large B-cell lymphoma is the most common type of NHL and accounts for about 30% of the cases. In this clinical report, we evaluated clinically and histopathologically a 64-year-old male patient who had mild pain and edema in his mandibular premolar region, and the excisional biopsy showed diffuse large B-cell lymphoma.
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Lu NN, Li YX, Wang WH, Jin J, Song YW, Zhou LQ, Wang SL, Liu YP, Liu XF, Yu ZH. Clinical behavior and treatment outcome of primary nasal diffuse large B-cell lymphoma. Cancer 2011; 118:1593-8. [PMID: 21837667 DOI: 10.1002/cncr.26452] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 06/21/2011] [Accepted: 06/23/2011] [Indexed: 01/08/2023]
Abstract
BACKGROUND Nasal diffuse large B-cell lymphoma (DLBCL) is rare. The objective of this study was to evaluate the clinical features and treatment outcomes of patients with nasal DLBCL. METHODS Twenty-five patients were included in the study. All patients received combination chemotherapy with or without radiotherapy. RESULTS Patients with nasal DLBCL usually were older and were predominantly men with early stage disease, low frequency of B symptoms and elevated lactate dehydrogenase (LDH), good performance status, and a low-risk international prognostic index (IPI) score. The overall response rate after initial treatment was 76%, the 3-year overall survival (OS) rate for the whole group was 44%, and the median OS was 35 months. Performance status and IPI were significant prognostic factors for OS. For patients with IPI scores of 0 or 1, the 3-year OS rate was 54%, and the median OS was 52 months compared with 17% and 11 months, respectively, for patients with IPI scores of 2 or 3 (P = .033). The prognosis for patients who achieved a complete response (CR) was significantly better than that for patients who did not achieve a CR. Extranodal spread was the primary pattern of failure. CONCLUSIONS The current results indicated that primary nasal DLBCL appears to have distinct clinical features; its poor outcome and propensity for extranodal failure illustrate the need for innovative therapies.
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Affiliation(s)
- Ning-Ning Lu
- Department of Radiation Oncology, Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Metgud RS, Doshi JJ, Gaurkhede S, Dongre R, Karle R. Extranodal NK/T-cell lymphoma, nasal type (angiocentric T-cell lymphoma): A review about the terminology. J Oral Maxillofac Pathol 2011; 15:96-100. [PMID: 21731288 PMCID: PMC3125667 DOI: 10.4103/0973-029x.80016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Extranodal NK/T-cell lymphoma, nasal type (ENKL) is a rare lymphoid neoplasm, which in the past has been grouped with a variety of granulomatous diseases. It is an aggressive non-Hodgkin’s type characterized clinically by aggressive, nonrelenting destruction of the midline structures of the palate and nasal fossa. Despite the malignant clinical course, histological diagnosis can be difficult because of extensive tissue necrosis and multiple biopsies that are often required and has an ominous prognosis, as the average survival rate is between 6 and 25 months as reported with a large number of Asian studies. Several American and European studies have shown similar results. This is the case report of a 60-year-old male patient who presented with nasal obstruction and foul smelling, ulcerative lesion over the palate of 6 months duration, which had been treated with antibiotics and anti-inflammatories without success. After performing a number of diagnostic tests, it was found histologically and confirmed by immunohistochemical analysis that the patient had an ENKL, nasal type (also known as angiocentric T-cell lymphoma).
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Affiliation(s)
- Rashmi S Metgud
- Department of Oral-Pathology, Rural Dental College, Pravara Rural university, LONI, Tal-Rahata, Ahmednagar, Maharashtra, India
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Franchi A, Palomba A, Cardesa A. Current diagnostic strategies for undifferentiated tumours of the nasal cavities and paranasal sinuses. Histopathology 2011; 59:1034-45. [PMID: 21457160 DOI: 10.1111/j.1365-2559.2011.03813.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Several malignant tumours occurring in the sinonasal tract may present with an undifferentiated morphology. Overall, these lesions pose significant diagnostic difficulties for the surgical pathologist, especially in limited biopsy material, but their correct classification is becoming increasingly important for an appropriate treatment strategy. This review deals with the criteria for differential diagnosis of these neoplasms, with emphasis on recent advances in immunohistochemistry and molecular biology, as well as with previous progress in electron microscopy. Through careful microscopic examination of haematoxylin and eosin-stained sections, in the light of clinical information and imaging data, a list of differential diagnoses can be made and an appropriate panel of antibodies can be chosen to further categorize the tumour. An initial panel including cytokeratins, synaptophysin, S100 protein, desmin and CD45 may allow the classification of most lesions or may help to narrow the list of differential diagnoses. Further refinement can be obtained through second-line markers, including in-situ hybridization for Epstein-Barr virus, other neuroendocrine markers, melanocytic markers, myogenin, CD99, other lymphocyte markers, and CD138 and light chains. Finally, molecular analysis can further assist in the recognition of specific entities such as nuclear protein in testis midline carcinoma, Ewing's sarcoma/peripheral neuroectodermal tumour, alveolar rhadbomyosarcoma, and poorly differentiated synovial sarcoma.
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Affiliation(s)
- Alessandro Franchi
- Division of Anatomic Pathology, Department of Critical Care Medicine and Surgery, University of Florence Medical School, Florence, Italy.
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Lindemann J, Wiesmiller K, Keck T, Kastl K. Dynamic nasal infrared thermography in patients with nasal septal perforations. Am J Rhinol Allergy 2009; 23:471-4. [PMID: 19807978 DOI: 10.2500/ajra.2009.23.3351] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Nasal obstruction is a typical symptom in patients with nasal septal perforations. Rhinomanometry and acoustic rhinometry are not reliable in these cases because the perforations generate incorrect results. Infrared thermography camera (ITC) systems allow contact-free intranasal recordings of the nasal surface temperature and the semiquantification of nasal airflow. The aim of this study was to perform contact-free temperature measurements of the nasal vestibular surface by application of ITC systems in patients with septal perforations to investigate the disturbed intranasal heat exchange and nasal airflow. METHODS The surface temperature profiles within the nasal vestibules of healthy volunteers (n=10) and patients with septal perforations (n=3) were recorded with an ITC during several breathing cycles. Thermal images were taken (60/s) displaying the surface temperature in degrees centigrade corresponding to a color scale. RESULTS The temperature recordings showed a disturbed intranasal heat exchange during inspiration and expiration in patients with septal perforations in comparison with healthy subjects. A reduced and irregular inspiratory cooling of the entire surface within the nasal vestibules visualizes a reduced and disturbed airflow volume. CONCLUSION The study was able to prove the feasibility of intranasal temperature recordings of the surface with an ITC system in patients with septal perforations. Contrary to rhinomanometry and acoustic rhinometry, thermography cameras can be applied to examine airflow in patients with septal perforations. The detected reduced cooling of the surface during inspiration might be a possible explanation for the patients' feelings of nasal obstruction.
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Affiliation(s)
- Joerg Lindemann
- Department of Otorhinolaryngology, University of Ulm, Ulm, Germany.
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Costes V. Pathologie lymphoïde de la tête et du cou. Ann Pathol 2009; 29:323-34. [DOI: 10.1016/j.annpat.2009.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 07/22/2009] [Indexed: 02/05/2023]
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Vedrine PO, Thariat J, Merrot O, Percodani J, Dufour X, Choussy O, Toussaint B, Dassonville O, Klossek JM, Santini J, Jankowski R. Primary cancer of the sphenoid sinus--a GETTEC study. Head Neck 2009; 31:388-97. [PMID: 18972425 DOI: 10.1002/hed.20966] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Primary involvement of the sphenoid sinus occurs in 2% of all paranasal sinus tumors and is associated with dismal prognosis. Optimal management remains debatable. METHODS A total of 23 patients were treated for a primary cancer of the sphenoid sinus from 1988 to 2004. Charts were reviewed for patient-, tumor-, and treatment-related parameters. Univariate and multivariate analyses were conducted to identify prognostic factors for locoregional control and survival. RESULTS Cranial neuropathies were present in 12 patients. Pathologic findings included adenoid cystic carcinoma, adenocarcinoma, lymphoma, squamous cell carcinoma, sarcoma, neuroendocrine carcinoma, melanoma, and malignant hemangiopericytoma. All but 2 patients had stages III to IV cancer. Radiotherapy was performed in 18 patients and chemotherapy in 12. Of 10 patients undergoing surgery, total excision with grossly negative margins was achieved in 4 patients and subtotal resection in 6. Median locoregional control and overall survival were 12 and 41 months, respectively. On multivariate analysis, cranial neuropathy was associated with worse locoregional control and survival. Surgery was rarely complete because of advanced stages at presentation, but it yielded better outcomes than other treatments without surgery in non lymphoma-cases. CONCLUSION Early CT and MRI should be performed when facing aspecific, rhinological, or neuro-ophtalmological symptoms. Cranial neuropathies indicate a worse prognosis. Surgery, including debulking surgery, may be preferred to combined modality treatments without surgery. Its apparently favorable impact on prognosis would need to be tested in homogenous histological groups of patients, which is impossible because of the rarity of the disease. Highly conformal radiotherapy (adjuvant or definitive) should be encouraged and optimized with concurrent chemotherapy in advanced stages. Aggressive multidisciplinary management including surgery, chemotherapy, and radiotherapy should be encouraged and adapted on histology and tumor extensions. Progress is still warranted to improve outcomes.
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Wenig BM. Undifferentiated malignant neoplasms of the sinonasal tract. Arch Pathol Lab Med 2009; 133:699-712. [PMID: 19415944 DOI: 10.5858/133.5.699] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2009] [Indexed: 11/06/2022]
Abstract
CONTEXT The most commonly encountered malignant neoplasms of the sinonasal tract are the keratinizing and nonkeratinizing types of squamous cell carcinoma. However, this complex anatomic region may represent the site of aggressive, non-squamous cell epithelial and nonepithelial malignant neoplasms of varying histogenesis, which are grouped under the term undifferentiated malignant neoplasms. Frequently, these undifferentiated malignancies share clinical and light microscopic features, which makes differentiation of one from the other virtually impossible without the use of adjunct analyses (eg, immunohistochemistry, electron microscopy, or molecular biologic studies). These tumors often are clinically aggressive and usually fatal, despite all attempts at controlling disease. Nevertheless, differentiating these tumors has clinical import because advances in therapeutic intervention may increase survival with good quality of life, and in some instances may achieve a cure. OBJECTIVE To compare and contrast the clinical, light microscopic, and immunohistochemical features of sinonasal undifferentiated malignant neoplasms. DATA SOURCES Case-derived material and literature review. CONCLUSIONS A variety of undifferentiated malignant neoplasms occur in the sinonasal tract with overlapping clinical and pathologic findings. In limited biopsy material, differentiation of these tumor types can be challenging. The pathologist plays a primary role in establishing the correct diagnosis, which often necessitates the use of adjunct studies that allow for differentiating among these neoplasms.
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Affiliation(s)
- Bruce M Wenig
- Department of Pathology and Laboratory Medicine, Beth Israel Medical Center, St. Luke's-Roosevelt Hospitals, New York, New York 10003, USA.
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Peleg A, Heran MKS, White VA, Chang WY, Rootman J. Malignant lymphoproliferative disorders extending into the orbit from the paranasal sinuses. Orbit 2009; 28:80-87. [PMID: 19839889 DOI: 10.1080/01676830802656869] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND/AIMS To describe the clinical features, imaging, histologic spectrum, treatment and prognosis of patients with malignant orbital lymphoproliferative disorders extending from the paranasal sinuses. METHODS Patients were culled from the University of British Columbia Orbit Clinic (1977-2004) and their clinical charts, imaging and pathology specimens reviewed. RESULTS The study included 6 patients with non-Hodgkin's lymphoma (NHL) and 5 multiple myeloma (MM). Orbital symptoms at presentation were periorbital swelling, diplopia, proptosis and pain. Major clinical findings were globe displacement, abnormal ocular movements, periorbital fullness, fifth nerve hypoesthesia and inflammatory signs. Imaging showed a soft tissue mass in one or more sinuses invading the orbit. Three NHL patients were still alive at last follow-up with one patient lost to follow-up. Two NHL patients and all MM died. CONCLUSION Presenting symptoms of malignant orbital lymphoproliferative disorders extending from the paranasal sinuses include mass effect occasionally with infiltrative and inflammatory characteristics accompanied by symptoms of sinus disease. On imaging, a soft tissue mass in the sinuses and orbit with bone destruction is commonly seen. Biopsy is essential for conclusive diagnosis. Treatment should be initiated promptly as local symptoms are frequently relieved and survival is possible, especially in cases of NHL.
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Affiliation(s)
- Alan Peleg
- University of British Columbia and the Vancouver General Hospital, Canada
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Abstract
Die Gesichtsmitte (der Bezirk zwischen Oberlippe und Stirn) entwickelt sich zwischen der 4. und 8. Schwangerschaftswoche. [ 220] Der Stirnfortsatz bildet sich währen der 4. postovulatorischen Woche, aus ihm gehen die oberen und mittleren Anteile des Gesichts hervor. Die Oberkiefer- und Nasenwülste entwickeln sich unterhalb des Stirnfortsatzes. Am Ende der 4. Woche bilden zwei oberflächliche Verdickungen der Nasenwülste die Riechplakoden, die ektodermaler Herkunft sind und aus denen der Epithelbelag der Nasenhöhle und Nasennebenhöhlen hervorgeht. Die Plakoden stülpen sich ein und bilden die Riechgruben, aus denen die vorderen Choanen (Nasenlöcher) und weniger oberflächlich die primitiven hinteren Choanen entstehen. Die medialen Nasen- und Stirnfortsätze bilden das Nasenseptum, die Stirnknochen, Nasenknochen, die Siebbeinzellen- Komplexe und die oberen Schneidezähne. Die lateralen Nasen- und Oberkieferfortsätze vereinigen sich zur Bildung des Philtrum und der Columella. Das knorpelige Nasenskelet bildet sich während der 7. und 8. postovulatorischen Woche tief unterhalb der Nasen- und Stirnbeinknochen aus dem Chondrocranium. Die Nasennebenhöhlen entwickeln sich in der 6. Fetalwoche aus den lateralen Nasenwänden, und ihr Wachstum setzt sich nach der Geburt während des gesamten Kindes- und Jugendalters fort.
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Affiliation(s)
- Antonio Cardesa
- Department of Pathological Anatomy, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spanien
| | - Pierre Rudolph
- Pathologisches Institut, Mühlenstr. 31, 45759 Recklinghausen, Deutschland
| | - Thomas Mentzel
- Dermatopathologische Gemeinschaftspraxis, Siemensstr. 6/1, 88048 Friedrichshafen, Deutschland
| | - Pieter J. Slootweg
- Department of Pathology HP 437, University Medical Center St. Radbound, P.O. Box 9101, 6500 Nijmegen, Niederlande
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Marr-Belvin AK, Carville AK, Fahey MA, Boisvert K, Klumpp SA, Ohashi M, Wang F, O'Neil SP, Westmoreland SV. Rhesus lymphocryptovirus type 1-associated B-cell nasal lymphoma in SIV-infected rhesus macaques. Vet Pathol 2008; 45:914-21. [PMID: 18984796 DOI: 10.1354/vp.45-6-914] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Epstein-Barr virus (EBV) is a worldwide endemic gamma herpesvirus of the genus Lymphocryptovirus (LCV) that infects more than 90% of the world's population. EBV has been associated with a variety of malignancies, but it has a demonstrated role in lymphomas, especially in immunosuppressed individuals. Lymphomas of the nasal cavity, paranasal sinuses, and nasopharynx are uncommon and constitute less than 5% of all extranodal lymphomas. Sinonasal non-Hodgkin's lymphomas have been reported in patients infected with human immunodeficiency virus (HIV) at an increased frequency. Rhesus LCV (rhLCV), the rhesus viral homolog of EBV, has been cloned and is associated with B-cell lymphomas in immunosuppressed rhesus macaques. We report two cases of B-cell lymphoma within the nasal cavity from 2 simian immunodeficiency virus-infected rhesus macaques with acquired immunodeficiency syndrome. The B-cell phenotype and rhLCV association were demonstrated by immunohistochemistry and confocal microscopy. The majority of the nuclei of the neoplastic B lymphocytes were EBNA-2 positive. RhLCV type 1 sequences were verified from the neoplasms by polymerase chain reaction. Nasal lymphoma is an unusual presentation of rhLCV-associated B-cell lymphoma in immunosuppressed rhesus macaques. These tumors demonstrate comparable viral pathogenesis with EBV-induced nasal lymphomas in HIV-positive people.
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Affiliation(s)
- A K Marr-Belvin
- Harvard Medical School, Department of Pathology, New England Primate Research Center, Division of Comparative Pathology, Southborough, MA 01772-9102, USA
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Dolev Y, Young J, Manoukian JJ. Multifocal anaplastic large T cell lymphoma of the ethmoid sinuses, temporalis muscle and frontal lobe in a 17-year-old boy. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.pedex.2008.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Aiken AH, Glastonbury C. Imaging Hodgkin and non-Hodgkin lymphoma in the head and neck. Radiol Clin North Am 2008; 46:363-78, ix-x. [PMID: 18619385 DOI: 10.1016/j.rcl.2008.03.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Hodgkin (HL) and non-Hodgkin lymphoma (NHL) involving the head and neck have many overlapping imaging features. Definitive diagnosis depends on histology, but imaging trends may help distinguish lymphoma from other common pathologic entities in the head and neck. CT is useful for staging and assessing bony involvement, whereas MR imaging is performed for soft tissue detail in extranodal disease, especially when there is transpatial disease or intracranial or intraspinal extension. Positron emission tomography has become an important part of staging and surveillance imaging and is particularly useful to distinguish posttreatment fibrosis and residual tumor.
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Affiliation(s)
- Ashley H Aiken
- Department of Radiology, San Francisco General Hospital, University of California San Francisco, 1001 Potrero Avenue, Room 1x55, San Francisco, CA 94110, USA.
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Anand TS, Saxena YK, Shashidhar TB, Kumar S. Primary B cell lymphoma of paranasal sinuses: a diagnostic surprise. Indian J Otolaryngol Head Neck Surg 2008; 60:256-8. [PMID: 23120556 PMCID: PMC3450634 DOI: 10.1007/s12070-008-0087-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Primary lymphomas of paranasal cavities are rather uncommon entities. They have a variable presentation from fulminant destructive manifestations to chronic indolent type of disease. Chronic indolent form may mimic invasive fungal sinusitis in its presentation. Unless high index of suspicion is held and appropriate histopathology sections are taken from specimen, its diagnosis can be deceitful. We here by report a case of primary lymphoma of the paranasal sinuses which was radiologically and clinically suspected to be a invasive fungal sinusitis and later was proven to be a B cell lymphoma. Clinical similarities between lymphoma and invasive fungal sinusitis along with management issues are discussed in this article.
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Affiliation(s)
- T. S. Anand
- 4, Hemkunt Colony, Opp. Eros International Hotel, Nehru Place, New Delhi 110 048 India
| | - Y. K. Saxena
- 4, Hemkunt Colony, Opp. Eros International Hotel, Nehru Place, New Delhi 110 048 India
| | - T. B. Shashidhar
- 4, Hemkunt Colony, Opp. Eros International Hotel, Nehru Place, New Delhi 110 048 India
| | - Soumitra Kumar
- 4, Hemkunt Colony, Opp. Eros International Hotel, Nehru Place, New Delhi 110 048 India
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Nagasaki A, Miyagi T, Taira T, Shinhama A, Kojya S, Suzuki M, Aonahata M, Yoshimi N, Takasu N. Adult T-cell leukemia/lymphoma with multiple integration of HTLV-1 provirus presenting as an isolated paranasal sinus tumor: A case report. Head Neck 2008; 30:815-20. [DOI: 10.1002/hed.20730] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Abstract
T-Cell leukemias and lymphomas represent a less common and heterogeneous group of lymphoid neoplasms. Overall, they respond less well to chemotherapy and have a poorer prognosis than their B-cell counterparts. T-Cell tumors express a number of potential targets for receptor-directed antibody therapy; however, there is no available therapeutic monoclonal antibody for these diseases with comparable activity to that of rituximab in B-cell disorders. Despite this, alemtuzumab, a humanized anti-CD52 monoclonal antibody has demonstrated meaningful anti-tumor activity in a variety of T-cell malignancies. A number of other antibodies, modified antibodies and immunotoxins directed against targets such as CD2, CD4, CD5, CD25, CD30 and CD122 expressed on malignant T-cells are under investigation. The current status of receptor-directed antibody therapy for T-cell leukemia and lymphoma is reviewed.
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MESH Headings
- Alemtuzumab
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antibodies, Neoplasm/therapeutic use
- Antigens, CD/immunology
- Antineoplastic Agents/therapeutic use
- Humans
- Leukemia, T-Cell/diagnosis
- Leukemia, T-Cell/drug therapy
- Leukemia, T-Cell/immunology
- Lymphoma, T-Cell/diagnosis
- Lymphoma, T-Cell/drug therapy
- Lymphoma, T-Cell/immunology
- Prognosis
- Receptors, Cell Surface/antagonists & inhibitors
- Receptors, Cell Surface/immunology
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Affiliation(s)
- John C Morris
- Metabolism Branch, Center for Cancer Research, National Cancer Institute, Mark O. Hatfield Clinical Research Center, Bethesda, Maryland 20892-1457, USA.
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Lanier B, Kai G, Marple B, Wall GM. Pathophysiology and progression of nasal septal perforation. Ann Allergy Asthma Immunol 2008; 99:473-9; quiz 480-1, 521. [PMID: 18219827 DOI: 10.1016/s1081-1206(10)60373-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To review the prevalence, causes, and treatments of nasal septal perforation (NSP). DATA SOURCES A literature search was conducted in MEDLINE to identify peer-reviewed articles related to NSP using the keywords nasal septal perforation and septal perforation for articles published between January 1, 1969, and December 31, 2006, and references cited therein. STUDY SELECTION Articles were selected based on their direct applicability to the subject matter. RESULTS Causes of NSPs include piercings, exposure to industrial chemicals, illicit drug use, intranasal steroid use, surgical trauma, bilateral cautery, and possibly improper use of nasal applicators. Prevalence is poorly reported. Mechanisms of substance-induced NSP formation are not understood. Progression from epistaxis to ulceration to NSP could not be substantiated by the literature. CONCLUSION Depending on the patient, NSP may be viewed as desirable (nose rings), problematic (whistling, congestion), or inconsequential. Understanding the pathogenesis of NSP is important for the practicing physician required to make decisions about whether to recommend surgical correction or medical treatment. Although the etiology of NSP is overwhelmingly iatrogenic, there is an association with a number of medical diseases in addition to use of illicit drugs and/or prescription nasal sprays.
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Affiliation(s)
- Bobby Lanier
- Department of Pediatrics, University of North Texas, Fort Worth, Texas 76132, USA.
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