Uncommon Sinonasal Pathologies with Common Clinical Presentations

Case Report

Austin J Otolaryngol. 2015; 2(9): 1064.

Uncommon Sinonasal Pathologies with Common Clinical Presentations

Stephen MCS¹*, Raman EV¹ and Mishra S²

¹Department of ENT and Head & Neck Surgery, Manipal Hospitals, India

²Department of Pathology, Manipal Hospitals, India

*Corresponding author: Stephen MCS, Department of ENT and Head & Neck Surgery, Manipal Hospitals, Bengaluru, No: E906, Alpine Eco Apartments, Doddenakundi, Marathahalli, Bengaluru–560037, India

Received: December 02, 2015; Accepted: December 21, 2015; Published: December 24, 2015

Abstract

Sinonasal neoplasms form a diverse group in the routine clinical otolaryngology practice. The uncommon pathologies in guise of common clinical presentations require meticulous diagnostic evaluation and timely intervention. Hemato/lymphoid neoplasms are infrequent in the maxillary sinus and mimic common infective and inflammatory conditions. Here, we report two patients who presented with usual symptoms and imaging findings, histopathology following surgery revealed: plasmablastic lymphoma and plasmacytoma. We report these cases for their rarity, clinical dilemma, atypical presentation and better quality of life with adjuvant therapy.

Keywords: Maxillary; Sinonasal; Lymphoma; Plasmacytoma; Plasmblastic lymphoma

Abbreviations

DLBCL: Diffuse Large B-cell Lymphoma; ISH: In-situ Hybridization; EBER: Epstein-Barr Virus Related Expression RNA; NHL: Non-Hodgkins Lymphoma; LCA: Leukocyte Common Antigen; CD: Cluster Differentiation; MUM: Multiple Myeloma oncogene; ALK: Anaplastic Lymphoma Kinase; EPOCH: Etoposide/ Prednisolone/Vincristine/Cyclophosphamide/Doxorubicin; PBL: Plasmablastic Lymphoma; CHOP: Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone; CODOX-M/IVAC: Cyclophosphamide, Vincristine, Doxorubicin, High-dose Methotrexate/Ifosfamide, Etoposide, High-dose Cytarabine; DA-EPOCH: Dose-adjusted Etoposide, Prednisone, Vincristine, Cyclophosphamide, and Doxorubicin; MM: Multiple Myeloma; EMP: Solitary Extramedullary Plasmacytoma; EBV: Epstein Barr Virus; HHV: Human Herpes Virus

Introduction

With a spectrum of disease pattern common to maxillary sinus, neoplasms deserve a special mention. Early diagnosis and timely intervention cannot be over emphasized. The symptom presentation depends largely on the volume of the tumor mass and site of involvement.

Sinonasal neoplasms are rare with an annual incidence of ~1 per 100,000 cases worldwide [1]. They account for 0.2-0.8% of all malignant neoplasms and 3% of all head and neck neoplasms [2]. Maxillary sinus houses 77% of all paranasal sinus malignant tumors [2]. Tumors of epithelial cell origin are the commonest with 80% being squamous cell and adenocarcinoma [1].

However, hemato/lymphoid neoplasms of maxillary sinus are an important concern as treatment options and their natural clinical course vary. The etiology of these neoplasms unlike the epithelial tumors remains largely unknown. The most common lymphoid neoplasm in Asians are DLBCL (29%) and plasma cell neoplasms (17%) with a male predominance [3,4]. However, their presentation may cause a clinical dilemma.

Here, we report 2 patients with common clinical presentation and diagnosis was revealed only on surgical histopathology that directed further adjuvant treatment.

Case 1

A 57 year old female presented to the ENT outpatient with complaints of first episode unilateral epistaxis. There were no other significant positive histories. Clinical examination showed right deviated nasal septum. X-ray paranasal sinuses was suggestive of acute sinusitis with fluid level in the right maxillary sinus (Figure 1). Following a week of appropriate antibiotics, she continued to have self-limiting intermittent episodes of epistaxis and clinical findings were non-contributory.