Artikel
CLL manifestation in the paranasal sinuses – presentation of a rare case
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Veröffentlicht: | 8. Juli 2008 |
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Gliederung
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Background: Chronic lymphatic leukemia (CLL) is one of the most common malign lymphatic diseases of the adult. Usually the disease occurs in the peripheral blood, lymph nodes, or the hematopoetic bone marrow, an occurrence in the paranasal sinuses is extremely rare.
Results: We present the case of a 75 years old female patient who presented with symptoms of persistent frontal, retrobulbary headaches. The computed tomography showed an osteoma of a size of 16x8 mm in the left frontal sinus. As a secondary finding there was a cervical lymph node enlargement. Extra- and endonasale sinus surgery and a diagnostic extirpation of the lymph node were performed. The histopathological work up of the specimens showed extended infiltrations of monoclonal lymphocytes. Immunostaining confirmed the diagnosis of CLL with strong expression of BCL2, CD5, CD20 and CD79a. After completion of the staging Binet-stage B, Ray-stage 1, was noted. Because of manifestation close to the CNS a systemic therapy with fludarabine was started.
Conclusions: CLL within an osteoma of the frontal sinus is a very rare disease manifestation. The characteristics of the presented case emphasize the importance of histopathological work up of bony lesions of the paranasal sinuses, because they might harbour systemic disease. The biological aggressiveness of the tumour can be assessed by fluorescence in situ hybridisation and analysis of gene mutations.