Introduction: Non-Hodgkin’s Lymphoma (NHL) of the sinonasal tract is uncommon malignancies which is rare in the western world and account for only 0.17% of all lymphoma. In Asia, sinonasal lymphoma is more common, accounting for 7% of all NHLs and it is more likely to be of the natural killer/T-cell variety rather than B cell.
Methods: A 73-year-old female presented with a progressively increasing painful left cheek swelling and nasal obstruction associated with recurrent epistaxis for one month duration. Sudden visual impairment built within 3 days. Clinical examination showed a firm and mobile (2cm x 2cm) left cheek swelling. A diagnostic nasal endoscopy revealed a left nasal mass filling the entire nasal cavity up to vestibule. Ophthalmologic examination confirmed blindness on the left eye with no light perception. A computed tomography scan of the paranasal sinuses and orbit showed a heterogeneous enhancing soft -tissue mass measuring (8cm x 3cm x 4 cm) filling the entire left nasal cavity and extending to the ethmoid, sphenoid, maxillary sinus, infratemporal space, orbital space and nasopharynx with erosion of the lamina papyracea. Magnetic resonance imaging of the paranasal sinuses and orbit revealed a soft tissue mass (6cm x 3cm x 4 cm) within the left nasal cavity and extending into the ethmoid and sphenoid sinus involving the optic nerve. Immunocytochemistry revealed a predominance of large B-cell Non-Hodgkin’s lymphoma subtype. The malignant cells were positive for leukocyte common antigen and B cell markers (CD20, CD79a, Ki67 >90%).
Results: The patient was referred to the hematologist. Unfortunately patient was not willing to undergo further treatment for neither staging nor chemoradiation.                  Conclusions: The close co-operation between the pathologist and the surgeon with high index of suspicious are essential in the management of NHL of sinonasal tract.