Abstract
Malignant lymphoma of the ethmoid sinus is very rare. A case of diffuse large B-cell lymphoma (DLBCL) of the left ethmoid sinus is presented here. A 79-year-old Japanese man was consulted to our hospital because of head ache and disturbance of left eye movement. Nasal endoscopy revealed a tumor, and imaging modalities including CT and MRI detected a tumor in the left ethmoid sinus. The tumor was invasive into left eye and left nose. A biopsy was performed via the nasal cavity. The biopsy revealed a diffuse proliferation of atypical lymphocytes. The atypical lymphocytes were large and had enlarged hyperchromatic nuclei. Mitotic figures were scattered. Hodgkin's cells were absent. Follicular structures were not seen. Immunohistochemically, the tumor cells were negative for cytokeratins (AE1/2, polyclonal, KL-1, and CAM5.2, Dako) and epithelial membrane antigen, CD3, CD15, CD30, CD45RO, and TdT. In contrast, the tumor cells were positive for CD20, CD45, CD79α, and p53. KI-67 labeling was 100%. Light chain restriction was present; there were numerous λ-chain-positive cells, while κ-chain-positive cells were scant. The pathological diagnosis was DLBCL of the left ethmoid sinus. Imaging of the whole body revealed no tumors and lymphadenopathy other than the ethmoid DLBCL. The patient was treated with chemoradiation, and is now alive 3 months after the presentation. In conclusion, a very rare case of DLBCL of the ethmoid sinus was reported.
Keywords: Diffuse large B-cell lymphoma, ethmoid sinus, CD20, CD45, CD79α, and p53. KI-67
Introduction
Malignant lymphoma of the ethmoid sinus is very rare [1, 2]. A case of diffuse large B-cell lymphoma (DLBCL) of the left ethmoid sinus is presented here.
Case report
A 79-year-old Japanese man was consulted to our hospital because of head ache and disturbance of left eye movement. Nasal endoscopy revealed a tumor, and imaging modalities including CT and MRI detected a tumor in the left ethmoid sinus (Figure 1). The tumor was invasive into left eye and left nose. A biopsy was performed via the nasal cavity. The biopsy revealed a diffuse proliferation of atypical lymphocytes (Figure 2). The atypical lymphocytes were large and had enlarged hyperchromatic nuclei (Figure 3). Mitotic figures were scattered. Hodgkin's cells were absent. Follicular structures were not seen. An immunohistochemical study was performed with the use of Dako's Envision method (Dako, Glustrup, Denmark), as previously reported [3-5]. The tumor cells were negative for cytokeratins (AE1/2, polyclonal, KL-1, and CAM5.2, Dako) and epithelial membrane antigen, CD3, CD15, CD30, CD45RO, and TdT. In contrast, the tumor cells were positive for CD20 (Figure 4), CD45, CD79α, and p53. KI-67 labeling was 100% (Figure 5). Light chain restriction was present; there were numerous λ-chain-positive cells, while κ-chain-positive cells were scant. The pathological diagnosis was DLBCL of the left ethmoid sinus. Imaging of the whole body revealed no tumors and lymphadenopathy other than the ethmoid DLBCL. The patient was treated with chemoradiation, and is now alive 3 months after the presentation.
Figure 1.
CT findings. The left ethmoid sinus is filled with tumor. The tumor is invasive into right ethmoid sinus, left eye, and left nasal cavity.
Figure 2.
Low power view of the histology. There is diffuse proliferation of atypical lymphocytes. HE, × 40.
Figure 3.
High power view. The tumor cells are large, and had nuclear atypia. Nasal or paranasal glands are scattered. HE, × 200.
Figure 4.
Tumor cells express a B-cell marker (CD20). CD20 immunostaining, × 200.
Figure 5.
The Ki-67 labeling of tumor cells are 100%. Ki-67 (MIB-1) immunostaining, × 200.
Discussion
Primary lymphoma of the ethmoid sinus is very rare; to the author's knowledge only two cases of ethmoid sinus lymphoma were reported [1, 2]. One is T-cell rich B-cell lymphoma [1] and another is non-Hodgkin's lymphoma of unknown cell type [2]. The present case was primary lymphoma because no other tumors and lymphadenopathy were recognized in the body. The present tumor was positive for B-cell markers and negative for T-cell markers. The tumor cells were large, and were distributed diffusely. Hodgkin's cells were absent, and tumor cells were negative for a precursor lymphocyte antigen TdT. Light chain restriction was present. The Ki-67 labeling was 100% and p53 antioncogene product was positive, indicating the malignant nature of the tumor. Therefore, the present case was DLBCL, according to the criteria of WHO [6].
Malignant lymphoma of the nasal and paranasal cavities was very rare. In a large series, no lymphoma was found in 78 patients with malignant tumors of the nasal cavity and paranasal sinus; the most common was squamous cell carcinoma (n=25), undifferentiated carcinoma (n=14), minor salivary glands carcinoma (n=31), olfactory neuroblastoma (n=8), and transitional cell carcinoma (n=1) [7]. In addition, another large study of nasal and paranasal sinus malignancy demonstrated that there were no cases of malignant lymphoma of the 220 patients [8]. Therefore, primary lymphoma of the ethmoid sinus appears very rare. In summary, a very rare case of DLBCL of the ethmoid sinus was reported here.
Conflict of interest
The author has no conflict of interest.
References
- 1.Wang J, Sun NC, Weinstein SM, Canalis R. Primary T-cell rich B-cell lymphoma of the ethmoid sinus: A case report with 5 years of follow-up. Arch Pathol Lab Med. 2000;124:1213–1216. doi: 10.5858/2000-124-1213-PTCRBC. [DOI] [PubMed] [Google Scholar]
- 2.David S, Rupa V, Mathai E, Nair S. Non Hodgkin lymphoma of ethmoid sinus with rhinoorbital myasis. Indian J Cancer. 1996;33:171–172. [PubMed] [Google Scholar]
- 3.Terada T, Kawaguchi M, Furukawa K, Sekido Y, Osamura Y. Minute mixed ductal-endocrine carcinoma of the pancreas with predominant intraductal growth. Pathol Int. 2002;52:740–746. doi: 10.1046/j.1440-1827.2002.01416.x. [DOI] [PubMed] [Google Scholar]
- 4.Terada T, Tanigichi M. Intraductal oncocytic papillary neoplasm of the liver. Pathol Int. 2004;54:116–123. doi: 10.1111/j.1440-1827.2004.01594.x. [DOI] [PubMed] [Google Scholar]
- 5.Terada T, Kawaguchi M. Primary clear cell adenocarcinoma of the peritoneum. Tohoku J Exp Med. 2005;206:271–275. doi: 10.1620/tjem.206.271. [DOI] [PubMed] [Google Scholar]
- 6.Gatter KG, Warnke RA. Diffuse large B-cell lymphoma. In: Jaffe ES, Harris NL, Stein H, Vardiman JW, editors. WHO Classification of tumour. Pathology and Genetics of tumors of haematopoietic and lymphoid system. Ryon: IARC Press; 2001. pp. 171–174. [Google Scholar]
- 7.Karz TS, Mendenhall WM, Morris CG, Amdur RJ, Hinerman RW, Villaret DB. Malignant tumors of the nasal cavity and paranasal sinuses. Head and Neck. 2002;24:821–829. doi: 10.1002/hed.10143. [DOI] [PubMed] [Google Scholar]
- 8.Dulguerov P, Jacobsen MS, Allal AS, Lehman W, Calcaterra T. Nasal and paranasal sinus carcinoma: are we making progress? A series of 220 patients and a systemic review. Cancer. 2001;15:3012–3029. doi: 10.1002/1097-0142(20011215)92:12<3012::aid-cncr10131>3.0.co;2-e. [DOI] [PubMed] [Google Scholar]