Primary Burkitt's Lymphoma in the Nasal Cavity and Paranasal Sinuses
A 44-year-old man presented with a 2-month history of right nasal obstruction. The patient had underwent functional endoscopic sinus surgery, after failure of 2 month medical therapy at other institution. Since frozen sections during the sinus surgery revealed malignant cells, he was referred to our hospital. The patient had no specific past history. A physical examination revealed postoperative synechia in the right nasal cavity. Magnetic resonance imaging (MRI) showed a large mass infiltrating the posterior aspect of the right maxillary sinus with extension into the posterior portion of the bilateral nasal cavity, nasopharynx, and right parapharyngeal, masticator and buccal spaces (). Biopsy slides from the first hospital revealed a typical "starry-sky" pattern. In immunohistochemical staining, cells were positive for CD10 and CD20 and negative for CD3. All cells were positive for Ki-67 antigen. Chest X-rays, abdominopelvic CT and bone scan showed no evidence of metastasis. A PET, CSF, and BM examination revealed no specific findings. The patient was seronegative for HIV. He was initiated on chemotherapy, consisting of cyclophosphamide, vincristine, doxorubicin, methotrexate, ifosfamide, etoposide, and cytarabine. He received a total of four cycles of chemotherapy. Nine months after chemotherapy, follow-up MRI showed no evidence of remnant tumor (). After 5 years, there was no recurrence on MRI and chest X-ray.