DLBCL Sphenoid Lymphoma: Diagnosis with Endoscopic Transphenoid Approach

Case Report

Austin ENT Open Access. 2024; 4(1): 1011.

DLBCL Sphenoid Lymphoma: Diagnosis with Endoscopic Transphenoid Approach

Liva GA¹*; Karatzanis A¹; Spanaki C²; Doulaptsi M¹; Prokopakis E¹

¹Department of Otorhinolaryngology, School of Medicine, University of Crete, Greece

²Department of Neurology, School of Medicine, University of Crete, Greece

*Corresponding author: Liva G Department of Otorhinolaryngology, School of Medicine, University of Crete, Armonias 14, 71409 Heraklion, Crete. Tel: +306978930266 Email: georgialiva21@gmail.com

Received: December 09, 2023 Accepted: January 04, 2024 Published: January 11, 2024

Abstract

Non-Hodgkin lymphomas of the paranasal sinuses are rare pathologies that present as a diagnostic challenge for the clinician. We describe a case of sphenoid lymphoma in an 81 year old patient presenting with loss of the papillary light reflex on both sides, left upper eyelid drop, anisocoria, and ocular movement deficiency of the left eye. MRI showed a solid lesion of the sphenoid sinus invading the clivus, the left carvenous sinus, the superior orbital fissure and the left side of the pituitary gland. Due to clinical difficulty to reach a diagnosis, endoscopic transphenoid biopsy was performed and DLBCL non-Hodgkin lymphoma of the sphenoid sinus was revealed from histopathological examination. The patient was treated with R-CHOP regi-men (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) with remarkable improvement after the first course of chemotherapy. NHLS and especially DLBCL are extremely rare in the sphenoid sinus. Therefore, high clinical awareness and early endoscopic biopsy are mandatory.

Keywords: Lymphoma; Hodgkin lymphoma; Non-Hodgkin lymphoma; Sphenoid sinus

Case Presentation

An eighty-one year old female with medical history of diabetes type II, rheumatoid arthritis, and hyperlipidemia, was referred to the emergency department of a tertiary re-ferral center with inflammation and drop of her left upper eyelid since the last twenty days. The clinical examination revealed loss of the papillary light reflex on both sides, left upper eyelid drop, anisocoria and ocular movement deficiency of the left eye. In addition, drop of the left nasolabial fold, hypoesthesia of the V3 branch and hyperalgesia of the V1 branch of the left half of her face. Function of the remaining cranial nerves was clinically normal and there were no sensory or motor deficits in the upper and lower extremities, while all tendon reflexes were normal. No palpable cervical lymphadenopathy was rec-ognized and physical and endoscopic examination of the nasal tract, larynx and pharynx were normal. Magnetic Resonance Imaging (MRI) scanning of the head with gadolinium injection was performed on an emergency basis and showed a solid heterogenous contrast intake, invading the clivus, the left cavernous sinus, without the presence of thrombosis of the cavernous sinus, and the interior carotid artery, the superior orbital fissure, and the left side of the pituitary gland, causing displacement of the pituitary gland to the right side (Figure 1,2).