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KUANetal.

TABLE XXVI.1 (Continued) Study

Year LOE Study design Study groups

Clinical endpoints Conclusion

Kojima et al. 1893 1992 4

2-year survival was worse for ENKTL than B cell

1. Histopathology 2. Treatment outcomes

Retrospective case series

20 NHL of the

sinonasal cavity treated at a single center

Marsot-Dupuch et al. 1802

1992 4

Retrospective case series

13 patients with

Imaging findings

1. Eight of the 13 had ENKTL; CT was useful for bony erosion and planning radiotherapy 2. MRI also helpful for defining extent of disease versus trapped secretions 1. B-cell and T-cell sinonasal NHL are associated with EBV in Western as well as in Asian patients 2. EBV may have a role in

diagnosis of lethal midline granuloma

Weiss et al. 1894

Evidence of EBV

1992 4

Retrospective case series

Eight sinonasal and 10 Waldeyer’s ring non-Hodgkin lymphoma patients

DNA using in situ hybridization

oncogenesis in NHL of the upper aerodigestive tract Abbreviations: DLBCL, diffuse large B-cell lymphoma; DSS, disease-specific survival; ENKTL, extranodal NK/T-cell lymphoma; NHL, non-Hodgkin’s lymphoma; OS, overall survival; SEER, Surveillance, Epidemiology, and End Results.

A comprehensive head and neck physical exam is encouraged for all patients and is of special concern in patients with concern for malignancy. Attention should be paid to cranial nerve deficits, which are suggestive of more aggressive disease. 1798 Nasal endoscopy is the standard of care for patients with sinus complaints and should be included when evaluated for sinonasal lymphoma as well. 1 In addition to the initial diagnosis, nasal endoscopy plays an important role in evaluation of the extent of disease and local invasion. Examination for invasion of local struc tures is important given that at the time of diagnosis in one series, 50% of ENKTL patients had involvement of the hard palate, orbit, and/or nasopharynx, and it is not uncommon inBCL. 1799 Indeed, local destruction of structures is a hall mark of ENKTL. 1800 In cases of orbital invasion, patients may experience painless eyelid swelling and extraocular muscle involvement with ophthalmoplegia. 1801 Aggregate grade of evidence : C (Level 4: 11 studies) C Imaging for lymphoma There are multiple options for imaging of lymphoma of the head and neck. Both CT and MRI are generally recommended to evaluate bony destruction and soft tis sue invasion, respectively. 1799,1800,1802 A number of studies have noted that ENKTL and DLBCL can be differenti ated on MRI in most patients, with ENKTL more com monly located in the nasal cavity with a heterogeneous appearance and DLBCL was more likely to be in the paranasal sinus and homogeneous. 1803–1806 It is worth noting that some authors have noted that ENKTL and

granulomatosis with polyangiitis can look similar on diag nostic imaging. 1807 DW-MRI has also been helpful in differentiating NK/T-cell and DLBCL. 1808 Wang et al. also noted the ability of DW-MRI in differentiating lymphomas from other carcinomas with lower ADC for sinonasal lymphoma. 1808 Finally, King et al. examined MRIs of patients with Waldeyer’s ring and sinonasal DLBCL and found that nodal and multifocal diseases were predictors of metastatic disease beyond the neck. 1809 In addition to locoregional imaging, full body scans are important for complete staging and prognostication. Most commonly, PET/CT is performed to evaluate hyperme tabolic lesions. Alternatively, contrasted chest, abdomen, and pelvis CT scans can be obtained, but potentially may miss nonclinically enlarged lymph nodes that harbor dis ease. The cost–benefit ratio between these two imaging paradigms has not been well studied in ENKTL and there have been no studies to date on full-body imaging in sinonasal lymphoma. D Histopathology Obtaining the correct pathologic diagnosis is critical for the management of sinonasal lymphoma. This involves biopsy of the lesion and collaboration with a head and neck pathology team for analysis. Sufficient tissue should be obtained from the biopsy to enable appropri ate hematopathological analysis including at least one paraffin block representative of tumor. 1810 In addition to performing a biopsy and histological analysis, several stud ies have examined laboratory markers, flow cytometry, and