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B-cell Lymphoblastic Lymphoma Presenting as a Sinonasal Mass: A Case Report
Brandon J Vilarello1, Patricia T Jacobson2, David A Gudis2,1
1Vagelos College of Physicians and Surgeons, Columbia University, New York, USA.
Cureus
|May 13, 2024
Summary
B-cell lymphoblastic lymphoma (B-LBL) is a rare childhood cancer. This case highlights a unique presentation of B-LBL in the sinonasal region, emphasizing the need for thorough investigation beyond initial symptoms.
Area of Science:
- Pediatric Oncology
- Head and Neck Pathology
- Hematologic Malignancies
Background:
- B-cell lymphoblastic lymphoma (B-LBL) typically affects lymph nodes outside the bone marrow and is common in children.
- Common symptoms include lymphadenopathy, fatigue, anemia, and thrombocytopenia.
- Head and neck manifestations are rare initial presentations of B-LBL.
Observation:
- A 5-year-old girl presented with facial swelling and maxillary sinus opacification, initially treated for sinusitis.
- Symptoms partially resolved with antibiotics and steroids, but bony erosion persisted.
- Normal initial laboratory values, including CBC, complicated the diagnosis.
Findings:
- Imaging and biopsy revealed B-cell acute lymphoblastic leukemia/lymphoma (B-ALL/LBL).
- The patient was ultimately diagnosed with Murphy's stage III B-cell lymphoblastic lymphoma.
- This represents a rare primary sinonasal occurrence of B-LBL in a child.
Implications:
- Sinonasal B-LBL can mimic common pediatric head and neck pathologies like sinusitis or benign tumors.
- Maxillary bone erosion is a critical sign warranting further investigation for malignancy.
- An initial response to antibiotics and steroids should not preclude consideration of underlying malignancy in pediatric sinonasal masses.
