Diffuse large B cell lymphoma originating from the maxillary sinus with skin metastases: A case report and review of literature

Figure 1 A plain computed tomography scan on day 1. The 3 cm × 3.1 cm × 3 cm sized left maxillary sinus of the patient was completely filled with mass, and a partially high-density area was confirmed inside.

Figure 2 Appearance of the body. A: Day 31. Left ptosis was confirmed; B: Day 31. When we opened his eyes passively, hyperexophoria of the left eye was confirmed; C: Day 62. Left circumocular swelling was confirmed. At this time, the patient could not open his left eye; D: Day 62. Chest of the patient. Multiple skin tumors were confirmed; E: Day 62. Chest and abdomen of the patient. Multiple skin tumors were confirmed.

Figure 3 Histopathological images of the biopsy specimen from the left maxillary sinus mass taken on day 50. A: Aggregates of large atypical lymphocytes with irregular nuclei having uneven chromatin and small to large nucleoli are evident in a necrotic background. Some cells show multilobulated nuclei. Mitosis and apoptotic bodies are conspicuous. Hematoxylin and eosin staining (× 200 magnification); B: Cluster of differentiation 20-positive cells were confirmed through immunohistochemical staining (× 400 magnification); C: Bcl-6-positive cells were confirmed through immunohistochemical staining (× 400 magnification); and D: MUM1-positive cells were confirmed through immunohistochemical staining (× 400 magnification).

Figure 4 A plain computed tomography scan on day 62. A: The 4 cm × 3.5 cm × 4 cm sized left maxillary sinus was completely filled with mass, and it was oppressed, involved the orbital base, destroyed the anterior, internal, and external walls, and protuberated outside; B: Chest. Pulmonary window setting. Multiple tumors (0.5-1.5 cm in size) were confirmed in both lungs; C: Chest. Mediastinal window. Multiple subcutaneous tumors and chest wall tumors were confirmed (orange arrows); and D: Abdomen. An abdominal paraaortic lymph node swelling (3 cm in size) and a left kidney nodule (1-2 cm in size) were confirmed (orange arrows).

Figure 5 Histopathological images of the biopsy specimen from skin mass taken on day 70. A: Aggregates of large atypical lymphocytes with irregular nuclei having uneven chromatin and small to large nucleoli are evident in a necrotic background. Some cells show multilobulated nuclei. Mitosis and apoptotic bodies are conspicuous. Hematoxylin and eosin staining (× 40 magnification); B: Aggregates of large atypical lymphocytes with irregular nuclei having uneven chromatin and small to large nucleoli are evident in a necrotic background. Some cells show multilobulated nuclei. Mitosis and apoptotic bodies are conspicuous. Hematoxylin and eosin staining (× 200 magnification); and C: CD20-positive cells were confirmed through immunohistochemical staining (× 400 magnification).

Figure 6 Clinical course of the patient. The patient initially visited our hospital on day 1. A diplopia occurred on day 31, and a maxillary sinus biopsy was performed on day 50. Afterwards, he was admitted on day 62 due to rapid deterioration of his condition, and a skin biopsy was performed on day 70. He died on day 80. WBC: White blood cell; CRP: C-reactive protein; LDH: Lactate dehydrogenase.