Sinonasal lymphoma

Radiopaedia • CC-by-nc-sa 3.0 • de

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

Clinical presentation

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 body weight loss.

Pathology

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

Radiographic features

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

CT

Soft tissue attenuating regions, either isoattenuating to the muscles or hyperattenuating due to a high nucleocytoplasmic ratio. CT is good at assessing associated bone destruction.

MRI

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+: contrast enhancement of lymphomas is variable, usually tends to be homogeneous in pretreatment lymphomas

Differential diagnosis