Primary Burkitt's Lymphoma in the Nasal Cavity and Paranasal Sinuses
A 25-year-old man presented with a 2-month history of nasal obstruction and right facial pain. The patient also had rhinorrhea, anosmia and headache. The patient had no specific past history. A physical examination revealed a pinkish, irregularly shaped mass in both nasal cavities (). A computed tomography (CT) showed an enhanced mass filling both ethmoid sinuses, the right nasal cavity and nasopharynx, with secondary destruction of the ethmoidal roof, both medial orbital walls and the anterior wall of the sphenoid sinuses. An endoscopic biopsy was taken. Pathologic evaluation showed "starry-sky" pattern of tightly packed, medium sized uniform lymphoid cells interspersed with large pale histiocytes. In immunohistochemical staining, cells were positive for CD10, CD20, and Bcl-6, and negative for CD3, CD5, and Bcl-2. Ninety percent of the cells were positive for Ki-67 antigen. The serum was negative for Epstein-Barr virus (EBV) and human immunodeficiency virus (HIV). Chest and abdominopelvic CT and bone scan showed no evidence of metastasis. Positron-emission tomography (PET) showed lymphoid invasion of the sphenoid, mandible, both humeri and the right proximal femur. Examination of cerebrospinal fluid (CSF) and bone marrow (BM) showed normal pathological and chromosomal findings. He was initiated on chemotherapy, consisting of cyclophosphamide, vincristine, methotrexate, ifosfamide, etoposide, and cytarabine. After three cycles, he was in complete remission on follow-up CT and PET. Five months after the end of chemotherapy, there was no evidence of recurrence on PET.