Sinonasal lymphoma: A primer for otolaryngologists

Abstract

Objective: Sinonasal lymphomas are a rare entity that commonly present with nonspecific sinonasal symptoms and are often recognized immediately. Through this review, we aim to summarize important principles in diagnosis and treatment of sinonasal lymphomas, with the goal of disseminating the current knowledge of this under-recognized malignancy to otolaryngologists.Methods: Systemic review using PRISMA guidelines of foundational scholarly articles, guidelines, and trials were reviewed focusing on clinical characteristics of key sinonasal lymphoma subtypes, along with available treatments in the otolaryngology, medical oncology, and radiation oncology literature.Results: Sinonasal lymphoma are derived from clonal proliferation of lymphocytes at various stages of differentiation, of which diffuse large B-cell lymphoma (DLBCL) and extranodal natural killer/T-cell lymphoma (ENKTL) are the most common. Diagnosis and staging require biopsy with immunohistochemistry in conjunction with imaging and laboratory studies. Treatment is ever evolving and currently includes multi-agent chemotherapy and/or radiation therapy. Conclusion:Otolaryngologists may be the first to recognize sinonasal lymphoma, which requires a comprehensive workup and a multidisciplinary team for treatment.Symptoms are nonspecific and similar to many sinonasal pathologies, and it is crucial for otolaryngologists to keep a broad differential.

Differentiation of Sinonasal NKT From Diffuse Large B-Cell Lymphoma Using Machine Learning and MRI-Based Radiomics

“…The T2_original_shape_Maximum2DdiameterColumn and T2_original_shape_LeastAxisLength parameters are demonstrated selected features, probably because the lesion size of DLBCL is typically larger than ENKTL at the time of MRI scanning due to delayed detection and erosion of adjacent areas, as is observed in the statistics by He et al 16 Meanwhile, the T2_original_shape_flatness and CE_original_gldm_DependenceVariance parameters may correlate with differences between those 2 in histology. Diffuse large B-cell lymphoma is defined histologically by a diffuse monomorphic infiltration of atypical lymphocytes, usually with minimal cytoplasm, resulting in limited necrosis 29,30 . Contrarily, ENKTL exhibits polymorphic infiltrates scattered among benign inflammatory cells, vascular centralization, and vascular invasion, which leads to varying degrees of local necrosis 30 …”

“…Diffuse large B-cell lymphoma is defined histologically by a diffuse monomorphic infiltration of atypical lymphocytes, usually with minimal cytoplasm, resulting in limited necrosis 29,30 . Contrarily, ENKTL exhibits polymorphic infiltrates scattered among benign inflammatory cells, vascular centralization, and vascular invasion, which leads to varying degrees of local necrosis 30 …”

“…Diffuse large B-cell lymphoma is defined histologically by a diffuse monomorphic infiltration of atypical lymphocytes, usually with minimal cytoplasm, resulting in limited necrosis. 29,30 Contrarily, ENKTL exhibits polymorphic infiltrates scattered among benign inflammatory cells, vascular centralization, and vascular invasion, which leads to varying degrees of local necrosis. 30 Moreover, the combined model performed better in our study, which was in agreement with many previous studies on other body components, 31,32 even though some researches 33 still had good outcomes using a single sequence model.…”

“…29,30 Contrarily, ENKTL exhibits polymorphic infiltrates scattered among benign inflammatory cells, vascular centralization, and vascular invasion, which leads to varying degrees of local necrosis. 30 Moreover, the combined model performed better in our study, which was in agreement with many previous studies on other body components, 31,32 even though some researches 33 still had good outcomes using a single sequence model. The best classifier for both single-sequence models was XGBOOST, which performed admirably in the training set but fell short of the combined model in the testing set.…”

International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors

“…Sinonasal lymphomas are rare and represent <1% of all head and neck cancers 1759,1760 . Lymphomas are classically divided into Hodgkin and non‐Hodgkin subtypes.…”