Atypical Location of Diffuse Large B-cell Lymphoma in the Nasal Septum

Abstract

Diffuse large B-cell lymphoma (DLBCL) is the most prevalent subtype of non-Hodgkin's lymphoma (NHL). This subtype can be present in various extranodal sites, including the brain, bones, intestines, kidneys, adrenal glands, and other soft tissues. As demonstrated in this case, one rare site of DLBCL is the nasal septum, which presents as a rapidly enlarging mass resistant to antibiotics and steroids. The definitive diagnosis for this case involved biopsy, but further workup, such as computed tomography (CT) and fluorescence in situ hybridization (FISH), helped support the diagnosis of DLBCL. While determining the stage of the lymphoma, treatment with R-CHOP chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) was initiated immediately. This case demonstrates a rare presentation of DLBCL in the nasal septum and describes the significance of urgent examination as well as treatment.

A Rare Case of Diffuse Large B-Cell Lymphoma Found in the Subcutaneous Scalp

“…Rare sites of extranodal DLBCL have been documented in the literature, including presentations in the scalp, testicles, bone, bladder, and nasal septum [2][3][6][7][8][9]. A recent 2022 study found that the percentages of extranodal DLBCL from years 2000-2015 at the age of 18 or greater in their search were as follows: GI tract 28.31%, nervous system 13.78%, head and neck 11.79%, skin and soft tissue 9.54%, genitourinary 7.24%, musculoskeletal 5.80%, respiratory tract 5.17%, pancreas and hepatobiliary 4.16%, endocrine organs 3.66%, heart and mediastinum 3.28%, breast 2.49%, bone marrow 2.47%, and others 2.30% [10].…”

“…Diffuse large b-cell lymphoma (DLBCL) represents approximately one-third of all non-Hodgkin's lymphomas [1]; extranodal presentation on the scalp is rare [2][3]. Rare extranodal presentations documented in the literature include the scalp, testicles, bone, bladder, and nasal septum, whereas, the gastrointestinal tract is the most common extranodal site [2][3][4][5][6][7][8][9]. Skin involvement in DLBCL can occur as a primary or secondary manifestation, which can be difficult to differentiate [1,4].…”