Nasopharyngeal diffuse large b-cell lymphoma in a teenage presenting with cavernous sinus syndrome: A case report

Primary lymphoma of the nasopharynx is uncommon and is more commonly seen as an association with other primary pathologies. Nasopharyngeal lymphoma is an aggressive tumor and can affect all age groups but is more commonly seen in middle-aged and older individuals. Majority of these tumors belong to the non-Hodgkin's group. Cavernous sinus syndrome (CSS) is a rare but severe complication indicating advanced aggressive stage of disease with direct extension of tumor into the cavernous sinus. Our patient is a young teenage 18-years old presented to emergency department with the symptoms of left jaw pain (4 months), facial swelling (1 month), bilateral nasal obstruction, dysphagia (1 month), visual loss in left eye and proptosis (1 week) along with weight loss. Magnetic resonance imaging (MRI) face and neck with contrast performed immediately revealed a nasopharyngeal mass with extension of disease into the left cavernous sinus encasing cavernous part of the left internal carotid artery (ICA), involvement of the left orbital apex, optic chiasm and pituitary gland. Histopathology later confirmed diffuse large B cell lymphoma (DLBCL). Laboratory investigations were unremarkable except for an elevated ESR. The patient underwent multidisciplinary management with combined chemotherapy and radiotherapy, demonstrating an excellent response on follow-up MRI and PET-CT, and was discharged with appropriate follow-up instructions. This case highlights early recognition with MRI and histopathological confirmation enables timely chemotherapy, improving outcomes and reducing the risk of permanent neurological sequelae.