PDF(Pubmed)
Abstract：
Non-Hodgkin lymphoma (NHL) is a hematological malignancy that can sometimes originate from the nasal cavities and paranasal sinuses. Patients who present with these tumors typically report sinonasal symptoms. However, a diagnostic challenge can arise when a patient\'s primary complaints include unique complex symptoms limited to the contralateral side of the tumor. This report describes the case of an 83-year-old man who presented to our center with a left-sided mass and right-sided proptosis with vision loss. After a nasal biopsy was taken, the patient was referred to the ophthalmology department to diagnose the cause of his ocular symptoms, which were not believed to be related to the mass. When biopsy results later returned as diffuse large B-cell lymphoma (DLBCL), an emergent repeat biopsy following lymphoma protocol was performed to confirm the diagnosis. A CT scan of the head and orbits showed generalized enlargement of the right optic nerve and extraocular muscles, and a positron emission tomography (PET) scan showed increased 18F-fluorodeoxyglucose (FDG) uptake in the right ethmoid sinus and orbit. The left-sided mass and right-sided symptoms resolved simultaneously with chemotherapy. This is the first documented case of a sinonasal mass causing ocular symptoms exclusively on the contralateral side. The presented diagnostic challenge highlights the importance of thorough investigations.
摘要：
非霍奇金淋巴瘤（NHL）是一种血液恶性肿瘤，有时可能起源于鼻腔和鼻旁窦。患有这些肿瘤的患者通常报告鼻窦症状。然而,当患者的主要主诉包括限于肿瘤对侧的独特复杂症状时，可能会出现诊断挑战。本报告描述了一名83岁男子的情况，他向我们的中心展示了左侧肿块和右侧突出并伴有视力丧失的情况。做了鼻部活检后,患者被转诊到眼科以诊断其眼部症状的原因，被认为与质量无关。当活检结果后来返回为弥漫性大B细胞淋巴瘤（DLBCL）时，根据淋巴瘤方案进行紧急重复活检以确认诊断.头部和眼眶的CT扫描显示右侧视神经和眼外肌广泛增大，正电子发射断层扫描（PET）扫描显示右筛窦和眼眶18F-氟代脱氧葡萄糖（FDG）摄取增加。左侧肿块和右侧症状与化疗同时缓解。这是第一例记录的仅在对侧引起眼部症状的鼻窦肿块。提出的诊断挑战强调了彻底调查的重要性。
