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B Liu, L Dong, W Shi, J Lv, L Guo, M Liu, Primary maxillary sinus lymphoma, QJM: An International Journal of Medicine, Volume 111, Issue 2, February 2018, Pages 119–120, https://doi.org/10.1093/qjmed/hcx226
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Case
A 58-year-old Chinese female was admitted to a tertiary hospital for 2-week of right facial numbness in September 2016. The subsequent magnetic resonance image (MRI) demonstrated a huge mass located in right maxillary sinus, which invaded the right nasal cavity and temporalis muscle anterior space. Then she underwent resection of right maxillary sinus tumor under nasal endoscope. The definitive pathology was diffuse large B cell lymphoma (DLBCL) (non-germinal central type) with positive immunohistologic stain for CD20, Paired box 5 (Pax-5), B-cell lymphoma 6 (Bcl-6), Multiple myeloma oncogene 1 (MUM-1), Forkhead box protein 1 (FOXP1), c-Myc (+50%) and Ki-67 (+90%). However, the post-operative 18F-fluorodeoxyglucose (FDG) positron emission tomography–computed tomography (PET/CT) scan manifested involvement of multiple bones, such as skull, mandible, vertebra, ribs and ilium. The bone marrow biopsy was negative. The patient was staged as IVA with international prognostic index (IPI) score of 1.4 cycles of chemotherapy with Rituximab-DA-EPOCH regimen and 2 cycles of chemotherapy with Rituximab + high dose-methotrexate (HD-MTX) were given. The post-chemotherapy PET/CT showed only minimal hypermetabolic lesion in right maxillary sinus. Then she received consolidated radiotherapy of 50 Gy to the residual lesion and 30 Gy to the initial involved sites. Only 3 months after radiotherapy, the patient complained of severe headache. The cranial MRI with contrast revealed a 2.6 cm × 1.6 cm × 1.1 cm lesion in the left pontine region (Figure 1A). The tumor was removed and the pathology was consistent with DLBCL. Half of a month later, she suffered from strength decrease of right limb. MRI demonstrated C1 and C5-6 spinal cord metastases (Figure 1B). This patient developed fatal central nervous system (CNS) involvement. Unfortunately, the patient succumbed to the disease in September 2017.
