Sinonasal Non-Hodgkin Lymphoma



Sinonasal Non-Hodgkin Lymphoma


Michelle A. Michel, MD









Figure 1 (Left) Axial CECT shows a large NHL image centered in the nasal cavity with slightly heterogeneous enhancement. There is gross destruction of the nasal septum image. Obstructed secretions image are noted in both maxillary sinuses. (Right) Axial STIR MR shows a large lymphoma involving the nasal cavity and ethmoid sinuses. Hypointense long TR signal is characteristic of this tumor with high nuclear to cytoplasmic ratio. Note the involvement of the right orbit image with resulting proptosis.






Figure 2 (Left) Coronal bone CT shows the classic location of sinonasal non-Hodgkin lymphoma. The mass is centered around the nasal septum, and there is destruction of the septum image as well as multiple ethmoid septations image. (Right) Axial T1WI C+ FS MR demonstrates a large lymphoma filling the left nasal cavity. The septum is displaced image but not eroded. Homogeneous mild enhancement is present. Trapped secretions image are present in the left antrum.



TERMINOLOGY


Abbreviations



  • Sinonasal non-Hodgkin lymphoma (NHL-SN)


  • Diffuse large B-cell lymphoma (DLBCL)


  • Natural killer/T-cell lymphoma (NKTL)


Definitions



  • NHL-SN: Extranodal lymphoproliferative malignancy most often of B-cell, T-cell, or NK/T-cell origin



    • NKTL: Subtype of peripheral T-cell lymphoma



      • NKTL previously called lethal midline granuloma, polymorphic reticulosis, angiocentric T-cell malignant lymphoma


IMAGING


General Features



  • Best diagnostic clue



    • Homogeneous soft tissue mass with predilection for nasal cavity ± bone destruction


    • Very nonspecific imaging features



      • NHL-SN can mimic variety of neoplasms & aggressive inflammatory disorders


  • Location



    • Nasal cavity > maxillary > ethmoid > frontal sinuses



      • NKTL may have simultaneous involvement of nasopharynx & oropharynx in addition to sinonasal cavities


  • Size



    • Usually between 2-5 cm


  • Morphology



    • Variable: Diffusely infiltrative & ill-defined, nodular, or bulky mass


CT Findings

Sep 20, 2016 | Posted by in HEAD & NECK IMAGING | Comments Off on Sinonasal Non-Hodgkin Lymphoma

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