CASE REPORT
Ethical approval for this case report was obtained from the
institutional review board of the Tokai University Hospital (approval
number 21R-269). The study was conducted in accordance with the Code of
Ethics of the World Medical Association (Declaration of Helsinki). The
institutional review board was responsible for anonymizing the patients,
and the requirement for informed consent was waived.
A 51-year-old man visited our clinic with the chief complaint of right
cheek pain. The right middle meatus was edematous and closed, and bloody
rhinorrhea was observed (Fig. 1). The Papanicolaou classification of
nasal cytology was Class Ⅲ (Cytology suggestive of, but not conclusive
for, malignancy) and CT revealed a right maxillary sinus shadow with a
partial bony defect, suggesting a malignant disease (Fig. 2ab). However,
MRI revealed an internally homogeneous lesion without contrast effect.
It exhibited low signal intensity on T1 and T2, and no invasion outside
the maxillary sinus, thus suggesting an inflammatory disease (Fig. 2cd).
Endoscopic right sinus surgery was performed under local anesthesia to
improve the right buccal pain via decompression and to confirm the
diagnosis. The right maxillary sinus contained a highly viscous mucus
reservoir and a large amount of yellowish-white debris. Allergic fungal
rhinosinusitis was suspected (Fig. 3ab). The histopathological diagnosis
was diffuse large B-cell lymphoma, based on the mucous accumulation and
debris from the sinus and its mucosa (Fig. 3cd). The patient underwent
radiochemotherapy, attaining disease remission.