Bilateral Sinonasal Lymphoma in the Absence of a Solitary Lesion: Case Report and Review of the Literature

Objective: Primary sinus lymphoma is rare, accounting for about 0.2 to 5% of extra nodal lymphomas. Lymphomas are the second most common malignancy in the head and neck after squamous cell carcinoma.

Methods: Case report

Results: We present the case of a 50-year-old African American female with an atypical presentation of sinonasal lymphoma. She had chronic nasal congestion and sinusitis for one-year duration. Computed tomography was significant for scattered mucosal thickening bilaterally in all paranasal sinuses; however, no discrete mass lesion was identified. She underwent functional endoscopic sinus surgery, and pathology was positive for diffuse large B-cell lymphoma. The multidisciplinary tumor conference recommended R-CHOP with intrathecal therapy. She deferred further treatment and was symptom-free without evidence of recurrent disease at 10 months post-surgery.

Conclusion: This case of bilateral sinonasal lymphoma with no mass lesion serves as a reminder to maintain a high index of suspicion for non-typical sinus pathology that may masquerade as chronic sinusitis.