Beware of malignant lymphoma masquerading as facial inflammatory processes

Considerable difficulty exists in diagnosing some sarcomas, lymphomas, and carcinomas that develop in the head and neck. Frequently these malignancies appear clinically as masquerading inflammatory disease processes. Recognition of these rare lesions usually occurs only after the inflammatory-like symptoms have failed to respond to conventional management, necessitating a more extensive evaluation and even repeated biopsies. The use of special stains, immunohistochemical studies, electron microscopy, and immunofluorescence techniques may still produce an inconclusive histopathologic diagnosis. This case report documents a rare extranodal malignant lymphoma of the right maxillary sinus that mimicked an odontogenic infection with superimposed chronic rhinosinusitis in a 19-year-old sailor. The cause of his chief complaint and presenting symptoms challenged the astuteness of clinicians, surgeons, and histopathologists on two continents and the high seas. Clinicians should maintain a high index of suspicion for malignancy when inflammatory-like lesions fail to respond to the usual appropriate management. Indications for early biopsy of suspect lesions and aggressive follow-up are emphasized.