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<p>Primary sphenoid sinus malignancies are rare, and sinonasal lymphomas comprise a small subset of head and neck cancers. Delayed recognition can lead to significant neuro-ophthalmic morbidity due to skull base involvement. A 73-year-old man presented with two years of anosmia followed by acute right ptosis and diplopia. Examination revealed right cranial nerve III, IV, and VI palsies and a level V cervical lymph node. Imaging showed a 3.6 × 2.7 × 3.3&#xa0;cm sphenoid sinus mass extending to the sellar region, cavernous sinuses, clivus, and optic apparatus. Endoscopic biopsy confirmed germinal centre B-cell–like diffuse large B-cell lymphoma with high Ki-67 (90–95%). The patient developed panhypopituitarism and was treated with hormone replacement and R-CHOP chemotherapy, achieving marked radiological and clinical response. Sphenoid sinus lymphoma may present insidiously with anosmia before rapid neuroophthalmic decline. Early imaging, biopsy, and multidisciplinary management are critical for timely, organ-preserving treatment and favourable outcomes.</p>

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Anosmia as a Sentinel Symptom of Primary Sphenoid Sinus Lymphoma: A Case Report and Literature Review

  • 期刊论文

  • 发表日期：

    2026年2月18日

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  • Wong Chyau Hong,
  • Ghin Ern Annie Chieng,
  • Ramiza Ramza bin Ramli

摘要

Primary sphenoid sinus malignancies are rare, and sinonasal lymphomas comprise a small subset of head and neck cancers. Delayed recognition can lead to significant neuro-ophthalmic morbidity due to skull base involvement. A 73-year-old man presented with two years of anosmia followed by acute right ptosis and diplopia. Examination revealed right cranial nerve III, IV, and VI palsies and a level V cervical lymph node. Imaging showed a 3.6 × 2.7 × 3.3 cm sphenoid sinus mass extending to the sellar region, cavernous sinuses, clivus, and optic apparatus. Endoscopic biopsy confirmed germinal centre B-cell–like diffuse large B-cell lymphoma with high Ki-67 (90–95%). The patient developed panhypopituitarism and was treated with hormone replacement and R-CHOP chemotherapy, achieving marked radiological and clinical response. Sphenoid sinus lymphoma may present insidiously with anosmia before rapid neuroophthalmic decline. Early imaging, biopsy, and multidisciplinary management are critical for timely, organ-preserving treatment and favourable outcomes.