Published online Mar 6, 2021. doi: 10.12998/wjcc.v9.i7.1654
Peer-review started: August 9, 2020
First decision: December 14, 2020
Revised: December 14, 2020
Accepted: January 22, 2021
Article in press: January 22, 2021
Published online: March 6, 2021
Primary non-Hodgkin’s lymphoma of the frontal sinus is extremely rare. In addition, Epstein-Barr virus (EBV) has been reported to play a role in the development of human immunodeficiency virus (HIV)-related malignant lymphomas. To the best of our knowledge, there is no report for the HIV-associated, EBV-positive primary diffuse large B-cell lymphoma (DLBCL) in the frontal sinus.
We present a unique case of HIV-associated, EBV-positive DLBCL in the frontal sinus in a 46-year-old man. Computed tomography of paranasal sinuses revealed dense opacification of the right frontal sinus with combined soft tissue swelling. Based on the clinical and radiological findings, the initial diagnosis was complicated frontal sinusitis, presenting Pott’s puffy tumor. Unexpectedly, HIV testing was positive on preoperative laboratory test, and the frontal sinus lesion was confirmed as EBV-positive DLBCL on biopsy.
Through this article, we suggest that EBV-positive DLBCL should be considered as possible diagnosis for patients with nonspecific space-occupying lesion of the paranasal sinuses. We also highlight an importance of clinical suspicion in diagnosing HIV infection because HIV serology is not routinely tested in patients with paranasal sinus problem.
Core Tip: Primary diffuse large B-cell lymphoma in the frontal sinus is extremely rare. It can mimic complicated sinusitis and may be easily overlooked at the initial diagnostic workflow in the clinical practice. When we meet the frontal sinus opacification with combined overlying soft tissue swelling, it is important for the radiologists and clinicians to include the following disease entity in the differential diagnosis based on imaging findings; complicated sinusitis (Pott’s puffy tumor), unilateral non-Hodgkin’s lymphoma and destructive metastasis. Awareness and clinical suspicion of this disease are necessary for making an accurate diagnosis and appropriate treatment, particularly in patients with a history of sinusitis which does not response to medical treatment, or in human immunodeficiency virus-positive patients.