When Snoring isn't just Snoring: Primary Nasopharyngeal Mantle Cell Lymphoma - A Rare Pathology in the Nasopharynx

Snoring is a common complaint in the primary care and otolaryngology clinic with a wide differential diagnosis. Primary nasopharyngeal mantle cell lymphoma is a rare cause of a nasopharyngeal mass, which can commonly manifest as snoring. The patient in this case presented with extensive history of recent worsening snoring as well as nasal congestion over the past several months. Additionally, the patient had previously undergone endoscopic sinus surgery several years prior but was lost to follow up. During nasal endoscopy, a nasopharyngeal mass was visualized with near-complete obstruction of the nasal airway. Intraoperative biopsies indicated MCL which is an uncommon pathology presenting in a rare location. Flow cytometry of the biopsy specimen was CD19+, CD20+, CD5+, and positive for lambda light chains with immunohistochemistry showed strong diffuse cyclin D1 nuclear staining on lymphoid cells. PET/CT and bone marrow biopsy were essential in staging disease, predicting success of treatment, and determining optimal treatment planning. Once the diagnosis was established, R-CHOP therapy alternating with R-DHAP for a total of six cycles. This case report highlights the importance of recognizing new or changing symptoms, appropriate diagnostic workup for lymphoma, as well as one of few case reports describing primary nasopharyngeal mantle cell lymphoma.