만성 부비동염으로 오인된 안와를 침범한 부비동 미만성 거대 B 세포 림프종 1예
A Case of Paranasal Diffuse Large B-Cell Lymphoma with the Orbital Invasion Masquerading as Chronic Sinusitis
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목적: 안와 및 대뇌 침범을 한 부비동형 미만성 거대 B 세포 림포종을 보고하고자 한다. 증례요약: 48세 남자는 내원 1달 전부터 발생한 코막힘 증상과 함께 우안 안구 돌출, 간헐적인 안구 주변 통증 및 두통을 주소로 내원하였다. 안구 돌출을 감별하기 위한 자기 공명 영상 소견상 종괴를 형성하는 병변이 우측 전두동에서 발견되었고, 우측 안와 상내측과우측 두개골 내 경막 침범이 의심되었으며 전반적인 양쪽 부비강의 염증성 점막 비후를 보였다. 응급으로 비강 내 절개 생검술을 시행하였다. 병리 조직 검사 결과 미만성 거대세포 B 림프종으로 진단되었다. 결론: 코곁굴 및 안와로 침범하는 종괴시 부비동염으로 오인되어 놓칠 수 있으며 극히 드물지만 미만성 거대 B 세포 림프종을 감별진단에 고려해야 한다.
Abstract
Purpose: To report a case of paranasal diffuse large B-cell lymphoma with orbital invasion extending to the intracranial lesion. Case summary: A 48-year-old male with chronic sinusitis visited our clinic for recent proptosis of his right eye, intermittent pain around the eyeball and headache. On a magnetic resonance image (MRI), a mass-like lesion was observed in the right frontal sinus, and its infiltration into the superior inner portion of the right orbital extraconal space and right intracranial dural space was suggestive of generalized inflammatory mucosal thickening in the paranasal sinuses. An incisional biopsy of the sinonasal tract was immediately performed. The pathology confirmed diffuse large B-cell lymphoma. Conclusions: A mass involving the paranasal sinus and orbit can masquerade as chronic sinusitis. Because diffuse large B-cell lymphoma is rare and is a high-grade aggressive malignant lymphoma, the possibility for diagnosis must be considered.
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