- 期刊
Diagnosis of Sinonasal Large B-cell Lymphoma with Orbital Invasion Using Computer-Assisted Navigation System in Endoscopic Sinus Surgery-Case Report
導航輔助內視鏡鼻竇深度切片手術診斷大B細胞淋巴瘤－病例報告
摘要
Sinonasal lymphoma is a rare malignancy. Sinonasal lymphomas are mainly non-Hodgkin's lymphomas as Hodgkin's lymphomas are rarely found outside lymph nodes. Most sinonasal non-Hodgkin's lymphomas in western countries originate from B cells, whereas in Asia non-Hodgkin's lymphomas are mainly of T-cell or NK-cell origin. In Taiwan, it is uncommon to find sinonasal B-cell lymphoma. The diagnosis of sinonasal lymphoma is often missed as its early symptoms are non-specific. Deep biopsies are necessary for adequate tissue collection. However, sinonasal lymphomas often cause considerable destruction of bony structures on presentation. The utilization of computer-assisted navigation system (CANS) ensures safety during surgery. A 79-year-old female came to our hospital due to right nasal obstruction and intermittent right epistaxis for several months. Computed tomography scan demonstrated an infiltrative tumor sized 3.1 × 2.2 × 3.4 cm that originated from the right ethmoid sinus with bony destruction of the right medial orbital wall, right frontal sinus, and right middle turbinate. Transnasal endoscopic sinus surgery was performed for tumor deep biopsy and volume reduction with the aid of CANS. Histopathological and immunophenotypic analysis showed diffuse large B-cell lymphoma (DLBCL), with a diagnosis of stage IIE disease according to the Ann Arbor staging system. The patient received subsequent cycles of rituximab combined with systemic chemotherapy and responded well to the treatment.
並列摘要
鼻腔鼻竇淋巴瘤為少見的惡性腫瘤。哈杰金氏淋巴瘤很少原發於淋巴結外，多數鼻腔鼻竇淋巴瘤為非哈杰金氏淋巴瘤。西方國家所發現之鼻腔鼻竇非哈杰金氏淋巴瘤多源自於B細胞，而亞洲國家多以T或NK細胞為主。在台灣，鼻腔鼻竇B細胞淋巴瘤並不多見。由於低盛行率加上鼻腔鼻竇淋巴瘤非特異性的早期症狀，因此鼻腔鼻竇淋巴瘤的診斷常被遺漏。淋巴瘤的診斷需要靠深入切片來收集足夠的病理組織。然而，鼻腔鼻竇淋巴瘤常侵蝕周圍構造，電腦輔助導航系統的應用可提升深入切片手術的安全性。1名79歲女性因右側鼻塞及間歇性右側鼻出血數月至本院就診，電腦斷層檢查發現一原發於右側篩竇，大小為3.1 × 2.2 × 3.4 cm的浸潤性腫瘤，伴有右眼眶內側壁、右側額竇和右側中鼻甲的骨質破壞。在導航系統的輔助下，進行經鼻內視鏡鼻竇深度切片手術，病理檢驗證實為瀰漫性大B細胞淋巴瘤，分期為Ann Arbor staging system IIE期。患者後續接受了數輪的化學免疫療法治療，治療反應良好。