Diffuse Large B-Cell Lymphoma of the Frontal Sinus Presenting as a Pott Puffy Tumor: A Case Report

Objective: Sinonasal non-Hodgkin lymphoma (NHL) is a very rare condition. NHL located specifically in the frontal sinus is an extremely rare condition with only 14 cases in the literature reported to date. A unique case of diffuse large B cell lymphoma of the frontal sinus who presented first and was treated as suspected Pott Puffy Tumor is presented along with a review of the literature.

Case Report: A 69-year-old Caucasian male with a history of sinusitis and two recent endoscopic sinus surgeries presented with enlargement of his right forehead. A computed tomography (CT) and magnetic resonance image (MRI) revealed a dense opacification of the frontal sinus bilaterally, thickening and enhancement of the dura matter behind the right frontal sinus and local osteomyelitis-like lytic bone changes. A bifrontal craniotomy was performed. Radical exoneration of the frontal sinus, copious antibiotic impregnated irrigation after culture swabs, and resection of presumed granulation tissue was performed. Culture swabs remained negative but histopathology revealed diffuse large B cell lymphoma. Subsequent chemotherapy was administered.

Conclusion: Sinonasal NHL is very rare but can occur in the frontal sinus and may present as suspected Pott puffy tumor. A high clinical suspicion is necessary for early diagnosis and treatment.