Hematolymphoid Lesions of the Sinonasal Tract

Abstract

Hematolymphoid neoplasms of the sinonasal tract are rare and the majority represents non-Hodgkin lymphomas. This review will focus on morphologic, immunophenotypic, and genetic characteristics of the most common types of non-Hodgkin lymphoma, namely diffuse large B cell lymphoma and extranodal natural killer/T-cell lymphoma, nasal type, but also include the discussion of less frequent other hematolymphoid entities, such as extranodal plasmacytomas and Rosai-Dorfman disease.

Keywords: DLBCL; Extranodal NK/T cell lymphoma; Plasmacytoma; Rosai–Dorfman disease; Sinonasal tract.

Fig. 1

Diffuse large B-cell lymphoma involving the maxillary sinus. a, b Diffuse sheets of large mature lymphoid cells with irregular nuclei and vesicular chromatin, as well as interspersed mitotic figures (hematoxylin and eosin, ×400 and ×1000). c Neoplastic cells are uniformly immunoreactive for the B-cell associated marker CD20 (×400). d CD10 is uniformly positive, suggesting a germinal center derived subtype of diffuse large B-cell lymphoma (×400)

Fig. 2

Extranodal NK/T-cell lymphoma, nasal type. a, b A diffuse infiltrate of medium sized lymphoma cells infiltrating mucosa (a; hematoxylin and eosin, ×400) and showing angiodestruction (b; hematoxylin and eosin, ×1000). Interspersed eosinophils, small lymphocytes, and neutrophils are also present. Neoplastic cells demonstrate irregular, elongated nuclei and hyperchromatic nuclei. c Lymphoma cells weakly co-express CD56 (×400). d In situ hybridization for EBER shows strong nuclear staining in neoplastic cells (×400)

Fig. 3

Extramedullary plasmacytoma involving nasal cavity. a, b Diffuse sheets of relatively small plasma cells with eccentrically located nucleus and abundant eosinophilic cytoplasm (hematoxylin and eosin, ×400 and ×1000). Few neoplastic plasma cells show nucleoli (solid black arrows) or Dutcher bodies (dashed black arrows). c Neoplastic plasma cells stain positively for cytoplasmic lambda light chains (×500). d They are negative for kappa light chains (×500)

Fig. 4

Flow cytometry immunophenotyping of a plasma cell neoplasm. Neoplastic plasma cells (orange) are positive for CD38 (a and b) and show cytoplasmic lambda light chain restriction (c). Furthermore, CD19 is aberrantly lost (d), while CD56 is aberrantly gained (e).

Fig. 5

Extranodal Rosai–Dorfman disease involving head and neck. a, b Aggregates of Rosai–Dorfman histiocytes with pale cytoplasm and surrounding inflammatory cells (a; hematoxylin and eosin, ×200). Emperipolesis is present (b; hematoxylin and eosin, ×1000). c Rosai–Dorfman histiocytes are immunoreactive for CD68 (c) and S100 (d) (×400)