Download PDF
J Neurol Surg Rep 2015; 76(01): e23-e27
DOI: 10.1055/s-0034-1543996
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Diffuse Large B-Cell Lymphoma of the Frontal Sinus Presenting as a Pott Puffy Tumor: Case Report

Nickalus R. Khan
1   Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
,
Goran Lakičević
2   Department of Neurosurgery, University Hospital Mostar, Bosnia and Herzegovina
,
Thomas R. Callihan
3   Pathology Group of the Midsouth, Memphis, Tennessee, United States
,
George Burruss
4   Department of Plastic Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
,
Kenan Arnautović
1   Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
5   Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, United States
› Author Affiliations
Further Information

Publication History

22 April 2014

18 July 2014

Publication Date:
16 January 2015 (online)

   Permissions and Reprints

Abstract

Objective Sinonasal non-Hodgkin lymphoma (NHL) is a very rare condition. NHL located specifically in the frontal sinus is even rarer with only 14 cases in the literature reported to date. A unique case of diffuse large B-cell lymphoma of the frontal sinus that presented first and was treated as suspected Pott puffy tumor is presented along with a review of the literature.

Case Report A 69-year-old white man with a history of sinusitis and two recent endoscopic sinus surgeries presented with enlargement of his right forehead. Computed tomography and magnetic resonance images revealed a dense opacification of the frontal sinus bilaterally, thickening and enhancement of the dura mater behind the right frontal sinus, and local osteomyelitis-like lytic bone changes. A bifrontal craniotomy was performed. Radical exoneration of the frontal sinus, copious antibiotic-impregnated irrigation after culture swabs, and resection of presumed granulation tissue was performed. Culture swabs remained negative, but histopathology revealed diffuse large B-cell lymphoma. Subsequent chemotherapy was administered.

Conclusion Sinonasal NHL is very rare but can occur in the frontal sinus and may present as a suspected Pott puffy tumor. A high clinical suspicion is necessary for early diagnosis and treatment.

Keywords

diffuse large B-cell lymphoma - frontal sinus - case report - Pott puffy tumor
 

  • References

  • 1 Howlader N, Noone AM, Krapcho M , et al , eds. SEER Cancer Statistics Review, 1975–2010. National Cancer Institute Web site. http://seer.cancer.gov/csr/1975_2010/
    PubMedGoogle Scholar
  • 2 Cleary KR, Batsakis JG. Sinonasal lymphomas. Ann Otol Rhinol Laryngol 1994; 103 (11) 911-914
    PubMedGoogle Scholar
  • 3 Fellbaum C, Hansmann ML, Lennert K. Malignant lymphomas of the nasal cavity and paranasal sinuses. Virchows Arch A Pathol Anat Histopathol 1989; 414 (5) 399-405
    CrossrefPubMedGoogle Scholar
  • 4 Burres SA, Crissman JD, McKenna J, Al-Sarraf M. Lymphoma of the frontal sinus. Case report and review of literature. Arch Otolaryngol 1984; 110 (4) 270-273
    CrossrefPubMedGoogle Scholar
  • 5 el-Hakim H, Ahsan F, Wills LC. Primary non-Hodgkin's lymphoma of the frontal sinus: how we diagnosed it. Ear Nose Throat J 2000; 79 (9) 738 , 741–743
    PubMedGoogle Scholar
  • 6 Neves MC, Lessa MM, Voegels RL, Butugan O. Primary non-Hodgkin's lymphoma of the frontal sinus: case report and review of the literature. Ear Nose Throat J 2005; 84 (1) 47-51
    PubMedGoogle Scholar
  • 7 Nemet AY, Deckel Y, Kourt G. Orbital invasion of frontal sinus lymphoma. Orbit 2006; 25 (2) 149-151
    CrossrefPubMedGoogle Scholar
  • 8 Chain JRK, Kingdom TT. Non-Hodgkin's lymphoma of the frontal sinus presenting as osteomyelitis. Am J Otolaryngol 2007; 28 (1) 42-45
    CrossrefPubMedGoogle Scholar
  • 9 Kim K, Kim MJ, Ahn S, Bae SY, Kim WS, Yoon JH. Frontal sinus lymphoma presenting as progressive multiple cranial nerve palsy. Yonsei Med J 2011; 52 (6) 1044-1047
    CrossrefPubMedGoogle Scholar
  • 10 Wong EH, Yang WY, Lowe D. Unilateral non-Hodgkin's lymphoma of the frontal sinus presenting as Pott's puffy tumour. Otolaryngol Pol 2013; 67 (4) 214-217
    CrossrefPubMedGoogle Scholar
  • 11 Philip JK, Al-Jassar A, Naquib IS, Usmani S, El-Kabani M, Refaat SM. Primary Non-Hodgkin lymphoma of frontal sinus diagnosed by fine needle aspiration cytology. Gulf J Oncolog 2013; 1 (13) 92-95
    PubMedGoogle Scholar
  • 12 Shohat I, Berkowicz M, Dori S , et al. Primary non-Hodgkin's lymphoma of the sinonasal tract. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004; 97 (3) 328-331
    CrossrefPubMedGoogle Scholar
  • 13 Duncavage JA, Campbell BH, Hanson GA , et al. Diagnosis of malignant lymphomas of the nasal cavity, paranasal sinuses and nasopharynx. Laryngoscope 1983; 93 (10) 1276-1280
    PubMedGoogle Scholar
  • 14 Hatta C, Ogasawara H, Okita J, Kubota A, Ishida M, Sakagami M. Non-Hodgkin's malignant lymphoma of the sinonasal tract—treatment outcome for 53 patients according to REAL classification. Auris Nasus Larynx 2001; 28 (1) 55-60
    CrossrefPubMedGoogle Scholar
  • 15 Spiro JD, Soo KC, Spiro RH. Nonsquamous cell malignant neoplasms of the nasal cavities and paranasal sinuses. Head Neck 1995; 17 (2) 114-118
    CrossrefPubMedGoogle Scholar
  • 16 Frierson Jr HF, Mills SE, Innes Jr DJ. Non-Hodgkin's lymphomas of the sinonasal region: histologic subtypes and their clinicopathologic features. Am J Clin Pathol 1984; 81 (6) 721-727
    PubMedGoogle Scholar
  • 17 Cooper DL, Ginsberg SS. Brief chemotherapy, involved field radiation therapy, and central nervous system prophylaxis for paranasal sinus lymphoma. Cancer 1992; 69 (12) 2888-2893
    CrossrefPubMedGoogle Scholar
  • 18 Hans CP, Weisenburger DD, Greiner TC , et al. Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry using a tissue microarray. Blood 2004; 103 (1) 275-282
    CrossrefPubMedGoogle Scholar
  • 19 Vidal RW, Devaney K, Ferlito A, Rinaldo A, Carbone A. Sinonasal malignant lymphomas: a distinct clinicopathological category. Ann Otol Rhinol Laryngol 1999; 108 (4) 411-419
    PubMedGoogle Scholar
  • 20 Quraishi MS, Bessell EM, Clark D, Jones NS, Bradley PJ. Non-Hodgkin's lymphoma of the sinonasal tract. Laryngoscope 2000; 110 (9) 1489-1492
    CrossrefPubMedGoogle Scholar
  • 21 Logsdon MD, Ha CS, Kavadi VS, Cabanillas F, Hess MA, Cox JD. Lymphoma of the nasal cavity and paranasal sinuses: improved outcome and altered prognostic factors with combined modality therapy. Cancer 1997; 80 (3) 477-488
    CrossrefPubMedGoogle Scholar
  • 22 Banooni P, Rickman LS, Ward DM. Pott puffy tumor associated with intranasal methamphetamine. JAMA 2000; 283 (10) 1293
    CrossrefPubMedGoogle Scholar