Rare primary site of manifestation of lymphoma

Lymphomas can be divided into Hodgkin lymphomas and non-Hodgkin lymphomas. Lymphomas are the second most frequent malignant tumors after squamous cell carcinomas, with an incidence of 2.5% in the head and neck region. It usually involves the Waldeyer's ring, the nasal cavity and/or paranasal sinuses, the orbit, or the salivary glands. Involvement of the temporal bone in the setting of generalized lymphoma has been described. Primary manifestation in the temporal bone only without systemic involvement is a rarity in the literature.

We report about a 73-year-old female patient who was transferred from outside to our hospital with clinical findings suspicious of otitis externa maligna. Initially, according to the patient, there was also a pronounced swelling in the area of the left temple. The radiological imaging showed a pronounced extracranial soft tissue swelling temporally, as well as extensive bony destruction in the lateral portion of the pars squamosa. With permeative pattern of osteolysis, radiological suspicion of lymphoma was raised, so histological confirmation was necessary induced. Biopsies were performed preauricular, retroauricular-temporal and mastoidal. Histopathological workup revealed diffuse infiltration by a mature, highly proliferative B-cell neoplasia (CD20-positive), specifically a diffuse large B-cell lymphoma (DLBCL). In further diagnostics, a bone marrow biopsy did not reveal any provable manifestation of diffuse large B-cell lymphoma. A positron emission tomography showed no further involvement besides the evidence of active lymphoma tissue on the left temporal side, so that a classification according to Ann Arbor IV/E is available with primary infiltration of the mastoid and the external auditory canal without systemic involvement.

Publication History

Article published online:
24 May 2022