title: Extranodal non-Hodgkin lymphoma of the sinonasal cavities: A 22-case report.
abstract: OBJECTIVE
  To determine presenting features, management and prognosis in extranodal non-Hodgkin lymphoma of the sinonasal tract.
  
  
  METHODS
  A retrospective study between 2004 and 2013 in the University Hospital Center of Nantes (France) recruited patients with lymphoma discovered by sinonasal involvement. Epidemiologic, diagnostic, clinical and prognostic criteria were analyzed, with survival studied on the Kaplan-Meier estimator and Log-rank test.
  
  
  RESULTS
  Twenty-two patients were included: 14 male, 7 female, with a mean age of 65 years at diagnosis. All had non-Hodgkin lymphoma, with strong predominance of diffuse large B-cell lymphoma (77%). Seven patients had risk factors for lymphoma (infection by HIV, EBV or chronic lymphocytic leukemia). A majority (68%) had advanced tumor at diagnosis (stage IV on the Ann Arbor classification). Most were located in the craniofacial bones (68%), mainly involving the maxillary or ethmoidal sinuses. The most frequent presenting symptoms were unilateral nasal obstruction, mucopurulent rhinorrhea, recurrent epistaxis or diplopia. Treatment consisted in chemotherapy, in some cases associated to radiotherapy. Overall survival was 82% at 12 months and 73% at 36 months. Recurrence-free survival was 76% at 12 months and 64% at 36 months.
  
  
  CONCLUSIONS
  Lymphoma is an aggressive pathology; revelation by sinonasal involvement is rare. Recommended treatment is chemotherapy, possibly associated to radiotherapy. Prognosis depends on histologic type, Ann Arbor stage at diagnosis and the therapeutic options available for the individual patient.
authors.affiliation: Service d'ORL et de chirurgie cervico-faciale, centre hospitalier universitaire de Nantes, Hôtel-Dieu, 1, place A.-Ricordeau, BP 1005, 44093 Nantes cedex 01, France.
authors.forename: M
authors.initials: M
authors.lastname: Lombard
authors.affiliation: Service d'ORL et de chirurgie cervico-faciale, centre hospitalier universitaire de Nantes, Hôtel-Dieu, 1, place A.-Ricordeau, BP 1005, 44093 Nantes cedex 01, France.
authors.forename: G
authors.initials: G
authors.lastname: Michel
authors.affiliation: Service d'ORL et de chirurgie cervico-faciale, centre hospitalier universitaire de Nantes, Hôtel-Dieu, 1, place A.-Ricordeau, BP 1005, 44093 Nantes cedex 01, France.
authors.forename: P
authors.initials: P
authors.lastname: Rives
authors.affiliation: Service d'anatomopathologie, centre hospitalier universitaire de Nantes, Hôtel-Dieu, 1, place A.-Ricordeau, BP 1005, 44093 Nantes cedex 01, France.
authors.forename: A
authors.initials: A
authors.lastname: Moreau
authors.affiliation: Service d'ORL et de chirurgie cervico-faciale, centre hospitalier universitaire de Nantes, Hôtel-Dieu, 1, place A.-Ricordeau, BP 1005, 44093 Nantes cedex 01, France.
authors.forename: F
authors.initials: F
authors.lastname: Espitalier
authors.affiliation: Service d'ORL et de chirurgie cervico-faciale, centre hospitalier universitaire de Nantes, Hôtel-Dieu, 1, place A.-Ricordeau, BP 1005, 44093 Nantes cedex 01, France. Electronic address: omalard@chu-nantes.fr.
authors.forename: O
authors.initials: O
authors.lastname: Malard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology; D004172:Diplopia / Q000209:etiology; D004844:Epistaxis / Q000209:etiology; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015508:Nasal Obstruction / Q000209:etiology; D000857:Olfaction Disorders / Q000209:etiology; D010255:Paranasal Sinus Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies
keywords: Ann Arbor staging; Nasal; Non-Hodgkin lymphoma; Sinus