Sinonasal lymphoma

Last revised by Mostafa Elfeky on 21 Jul 2023

Sinonasal lymphoma refers to the involvement of the nasal cavity and/or paranasal sinuses with lymphoma. It can be primary or secondary.

The most common locations of sinonasal lymphoma are the nasal cavity and the maxillary sinus. Generally, T cell lymphoma (especially nasal T/NK-cell lymphoma), commonly seen in Asian and South American populations, most frequently involves the nasal cavity, whereas B cell lymphoma, commonly seen in Western populations, usually involves the paranasal sinuses 5.

Presenting symptoms of sinonasal lymphoma are variable but are usually similar to those of benign inflammatory diseases. The clinical symptom spectrum includes nasal obstruction, rhinorrhea, bloody discharge/epistaxis, postnasal drip, facial swelling, neck mass, orbital symptoms, fever, and weight loss.

It can be represented by various cytological types but the most common forms to arise in the sinonasal area are thought to be DLBCL (diffuse large cell B cell lymphoma) followed by nasal NK/T-cell lymphoma 3. There is a predilection for involvement of the nasal cavities over the paranasal sinuses. 

Sinonasal lymphomas may be either seen as diffusely infiltrating lesions extending along the walls of paranasal sinuses and nasal cavity or as discrete sinonasal soft tissue mass-like lesions.

Soft tissue attenuating regions, either iso-attenuating to the muscles or hyperattenuating due to a high nucleocytoplasmic ratio. CT is useful for assessing associated bone destruction.

MRI is considered the optimal imaging modality for assessing locoregional extent of disease:

  • T1: lesions appear as intermediate signal pattern

  • T2/STIR: hypointense

  • T1 C+ (Gd): contrast enhancement of lymphomas is variable, usually tends to be homogeneous in pretreatment lymphomas

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