Recurrent Epistaxis in Nasopharyngeal Mass

Introduction:

The causes of nose bleeding are varied.

Methods:

Case report of a 78-year-old patient with recurrent epistaxis. The endoscopy revealed a furrowed mass of the epipharynx exceeding toward midline and choana.

Results:

The rest of the results was normal. A CT scan revealed an osseous destructive mass in the epipharynx and ethmoid sinus with transition to the right frontal sinus and protrusion to the left main nasal cavity a Dissolution of the osseous contours in the right medial orbital wall, partial of the orbital roof in the medial part and also a bony destruction at the roof of the right ethmoid sinus. We have performed a rhinoscopy with biopsy from the right side of epipharynx in general anaesthesia. The result of the epipharynx biopsy revealed a diffuse Large B-Cell Lymphoma of germinal center stage IV with regression and necrosis of the epipharynx. The cancer staging exposed a cystic mass of the spleen as a manifestation of the lymphoma.

Therapy:

Prephase with Vincristine; intrathecal administration of Methotrexate; immunotherapy R-CHOP-21-Scheme 4 from 6 cycles to date Rituximab 700 mg (375 mg/m2) Tbl; Cyclophosphamide 1000 mg (750 mg/m2) i.v.; Hydroxy-Doxorubicin (50 mg/m2) i.v.; Vincristine 1 mg i.v. Prednisolon 75 mg Tbl., Neulasta 6 mg s.c.

Conclusions:

The primary chemotherapy is currently the therapy of choice. The frequency of recurrence rate of patients with lymphoma is declining in the last 20 years at behalf of early diagnosis, staging and personalized therapy. The highly dosed R-CHOP-Scheme from 1976 is at the present the therapy of choice. In the near future new therapies like Chimeric Antigen Receptor (CAR) T-Cell as a revolutionary therapy with modified self antibodies are expected.

Publication History

Publication Date:
18 April 2018 (online)