Primary non-Hodgkin lymphoma of the sphenoid sinus with visual disturbance: A report of two cases

Abstract

Abstract. Primary non-Hodgkin lymphoma (PNHL) of the sphenoid sinus is a rare neoplasm that poses a diagnostic challenge to clinicians. The proximity of the optical nerve and canal to the sphenoid sinus is accountable for the high incidence of visual disturbance in PNHL of the sphenoid sinus. In particular, patients whose radiologic diagnosis reveals bone destruction in the lateral wall involved with optical-nerve-canals or cavernous sinus present a high risk of rapidly developing unilateral blindness. The present study reports 2 rare cases of PNHL of the sphenoid sinus. Sudden sight loss may follow minimally invasive biopsy. In such cases, the measures that must be taken for the prevention of permanent sight loss are limited in the absence of the final pathologic diagnosis.

Primary sphenoid lymphoma: Focus on imaging

“…The case described in the present study is unusual as the patient did not present visual disturbance or other neurologic symptoms except headache; therefore all the imaging examinations (CT, MRI, and FDG–PET–CT) were carried out at the early onset of the disease and allowed a comparison of the findings of the different imaging modalities. In the literature, there are few reports about imaging features of sphenoid lymphoma; Ye et al recently described CT features of sphenoid lymphoma, but MRI and PET–CT images are missing 9 ; on the other hand, Park et al reported MRI features, but CT and PET–CT images are not provided. 10…”

Sphenoid Lymphoma: A Diagnostic Challenge

“…This can be explained by postoperative edema and hematoma, which further impinged the optic and oculomotor nerve. Minimally invasive biopsies have caused sudden vision loss in some instances of sphenoid lymphoma [8]. An added advantage of this endoscopic sinus surgery is that it opens a window in the sphenoid sinus, permitting tumor monitoring and response to treatment by simple nasoendoscopy.…”

A practical overview of CT and MRI features of developmental, inflammatory, and neoplastic lesions of the sphenoid body and clivus

“…The “poorly differentiated” form is the most frequent sphenoid neuroendocrine tumour V–VI decade M = F Headache, epistaxis, and visual disturbances. A paraneoplastic syndrome due to the ectopic hormone production is rare Lymphoma [ 15 , 91 ] Primary sphenoid sinus lymphoma is very rare (only 20 cases described) > V decade M:F ratio = 3:1 Non-specific symptoms including recurrent sinusitis, nasal discharge, headache, and sight loss Multiple Myeloma/plasmacytoma [ 98 , 106 ] Head-neck localization is very rare. 75–80% of extramedullary plasmacytomas arise from the aerodigestive tract.…”

“…Non-Hodgkin diffuse large B-cell lymphoma is the most common histotype. Perineural spread, bony destruction, and dura mater, cavernous sinus, and intracranial involvement is often observed [ 91 ]. Unenhanced CT shows as a soft tissue mass without calcifications, chondroid, or osteoid matrix.…”