POSTER'7'
POSTIRADIATION'SPHENOID'MUCOCELE'–'A'RARE'COMPLICATION'
'
Carolina!Afonso,!Marília!Gomes!and!Letícia!Ribeiro!
!
Hematology! Department,! Coimbra! Hospital! and! University! Centre! (CHUC),! Coimbra,! Portugal!
!
Introduction!
Paranasal! sinus! mucoceles! are! epithelialJlined! cystic! lesions,! characterized! by! a! slow,!
expansive! tendency,! leading! to! thinning! and! erosion! of! one! or! several! of! its! bony! walls.!
Sphenoid!sinus!is!rarely!affected.!Mucoceles!following!radiotherapy!(RT)!are!rare.!We!report!
a!case!of!a!sphenoidal!mucocele!in!a!patient!who!had!received!RT!for!paranasal!diffuse!large!
BJcell!lymphoma!(DLBCL).!
Case'report!
A!65JyearJold!male!presented!with!complaints!of!headache,!nasal!congestion,!epistaxis!and!
epiphora! for! about! 6! months.! He! had! no! history! of! B! symptoms! or! visual! disturbances.!
Computed!tomography!(CT)!and!magnetic!resonance!imaging!(MRI)!of!brain!and!paranasal!
sinuses! showed! an! extensive! softJtissue! lesion! (60x50x51mm)! occupying! ethmoid! and!
sphenoid! sinuses,! with! local! bone! destruction! and! extension! to! adjacent! compartments,!
including:! anterior! cranial! fossa! (with! no! evidence! of! brain! parenchyma! invasion),! sella!
turcica! (leading! to! displacement! of! the! pituitary! gland),! right! orbit! (contacting! the! medial!
rectus! muscle)! and! nasal! cavities.! Biopsy! of! the! lesion! revealed! a! dense! proliferation! of!
medium! to! large! lymphocytes,! positive! for! CD20,! BCLJ2,! CD10,! BCLJ6! and! MUMJ1;! the!
pathologic! features! were! compatible! with! DLBCL.! Staging! CT! scan! (chest,! abdomen! and!
pelvis),! bone! marrow! biopsy! and! lumbar! puncture! were! all! negative! for! additional!
lymphomatous! involvement.! The! patient! was! treated! with! 8! cycles! of! RJCHOP! (rituximab,!
cyclophosphamide,! doxorubicin,! vincristine,! prednisolone)! plus! intravenous! highJdose!
methotrexate! (3! g/m2),! followed! by! local! irradiation! (36! Gy/18! fractions).! He! achieved! a!
complete!remission!and!was!kept!under!clinical!and!imaging!surveillance.!
Two! years! later! the! patient! presented! once! again! with! symptoms! of! nasal! obstruction,!
followed! by! diplopia.! Suspecting! of! local! tumor! recurrence,! a! MRI! scan! of! brain! and!
paranasal!sinuses!was!performed;!it!showed!a!wellJdefined!lesion!with!high!signal!intensity!
on! T1Jweighted! image! and! a! low! signal! intensity! on! T2Jweighted! image,! located! in! the!
sphenoid!sinus,!and!extending!to!the!posterior!ethmoidal!cells!and!to!the!right!nasal!cavity;!
this! lesion! was! in! close! proximity! to! dura! mater,! left! cavernous! sinus! and! intracanalicular!
segment!of!the!right!optic!nerve.!The!radiologic!features!were!suggestive!of!mucocele.!An!
endoscopic! transnasal! sphenoidectomy! was! performed,! with! a! full! resolution! of! patient!
symptoms.!
Conclusion!
Sphenoid! sinus! mucocele! is! an! uncommon! complication! of! RT! for! tumors! of! the! head! and!
neck!region,!and!few!cases!were!reported!in!the!literature.!Its!presentation!may!mimic!other!
sinonasal,!ophthalmic!and!neurological!disorders,!as!well!as!tumor!recurrence.!Imaging!is!of!
great!importance!in!establishing!an!accurate!diagnosis.!
! !
SCIENTIFIC PROGRAMME
SESSION I
HODGKIN’S DISEASE
DEBATE I
IS THERE STILL A ROLE
FOR COMBINED MODALITY
THERAPY FOR EARLY
STAGE CHL?
SESSION II
T-CELL LYMPHOMA
ROUNDTABLE I
FUTURE DIRECTIONS IN
T-CELL LYMPHOMA
SESSION III
FOLLICULAR LYMPHOMA
DEBATE II
CAN WE AVOID
CHEMOTHERAPY IN
THE MANAGEMENT OF
FOLLICULAR LYMPHOMA?
SESSION IV
RARE LYMPHOMAS –
MARGINAL ZONE
LYMPHOMA AND
WALDENSTRÖM M
ACROGLOBULINEMIA
ROUNDTABLE II – WHERE
TO GO IN RARE B-CELL
LYMPHOMAS
SESSION V
MANTLE CELL LYMPHOMA
SESSION VI
DIFFUSE LARGE B-CELL
LYMPHOMA
DEBATE III
DO WE STILL NEED ASCT
IN MCL?
SESSION VII
NOVEL THER APEUTIC
CONCEPTS IN B-CELL
LYMPHOMAS
SELECTED ABSTRACTS
FOR AN ORAL
PRESENTATION
SELECTED ABSTRACTS
FOR A POSTER
PRESENTATION
DISCLOSURES