Sinonasal lymphoma - A clinicopathologic analysis of 58 cases from the Massachusetts General Hospital

Few large series compare lymphomas of the nasal cavity with those of the pa ranasal sinuses. We studied the cases of 58 patients, 34 males and 24 femal es, aged 7 to 92 years (mean, 57 years), who had lymphoma involving the nas al cavity or paranasal sinuses. Thirty-three patients had diffuse large B-c ell lymphoma (DLBCL). Twenty-three were male and 10 were female, with an ag e range of 7 to 91 years (mean, 63 years); two were HIV-positive. Only 2 of 11 cases tested tone in an HIV-positive patient and one of lymphomatoid gr anulomatosis type) were Epstein-Barr virus (EBV)-positive. Thirty (91%) inv olved paranasal sinuses, 10 with nasal involvement, whereas three cases had nasal, but not sinus, involvement. At last follow-up, 16 (67%) were free o f disease 7 to 169 months later (mean, 65 months), and 8 (33%) had died of disease 2 to 166 months later (mean, 45 months). Seventeen patients had nas al-type natural killer (NK)/T-cell lymphoma. There were 10 women and 7 men, aged 27 to 78 years (mean, 48 years). Thirteen of 14 were EBV-positive. Si xteen patients had nasal involvement, eight with sinus involvement. Eleven (73%) of 15 were alive and well 6 to 321 months later(mean, 139 months), th ree (20%) died of lymphoma 1, 11, and 12 months later, and one (7%) is aliv e with disease. There was one case each of marginal zone B-cell lymphoma, B urkitt's lymphoma, Burkitt-like lymphoma, peripheral T-cell lymphoma of uns pecified type, and adult T-cell lymphoma/leukemia. In an additional three c ases, the lymphomas were composed predominantly of large cells, but no immu nophenotyping could be performed for subclassification. In 19 cases (17 DLB CLs, 1 Burkitt-like lymphoma, and 1 lymphoma of uncertain Lineage), present ing symptoms included complaints related to the eyes. In 16 cases (13 DLBCL s, 1 Burkitt-like lymphoma, 1 nasal NK/T-cell lymphoma, and 1 lymphoma of u ncertain lineage), the orbit was invaded by lymphoma. In our series, the mo st common lymphoma to arise in the sinonasal area is DLBCL, followed by nas al NK/T-cell lymphoma. Comparison of these two types of lymphoma showed tha t lymphomas involving sinuses without nasal involvement were predominantly DLBCLs (20 of 21), whereas nasal cavity lymphomas without sinus involvement were usually NK/T-cell type (8 of 11) (p = 0.000125). Compared with patien ts with DLBCL, patients with nasal NK/T-cell lymphoma were overall younger, with a lower male-to-female ratio. Lymphomas of B-cell lineage were more l ikely to be associated with symptoms related to the eyes (p < 0.0005) and t o have extension to the orbit (p < 0.01) than were lymphomas of T- or NK-ce ll lineage. In contrast to results of Asian studies in which nasal NK/T-cel l lymphoma has a very poor prognosis, our nasal NK/T-cell lymphomas had an outcome similar to that of DLBCL.