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We report on an unusual case of primary extranodal non-Hodgkin’s lymphoma of the sphenoid sinus invading cavernous sinus. A 69-year-old male patient presented with left facial pain and headache. A nasal endoscopy revealed no specific finding in both nasal cavity and no definite mass like lesion was found in the nasal cavity. Paranasal CT scans demonstrated mild haziness without bony erosion or thinning in left sphenoid sinus. Several months later, he complained of a ptosis and lateral gaze palsy of the left eye when he gazed at the left side. Brain MRI showed a well enhanced lobulated mass in the left sphenoid sinus invading into the left carvenous sinus and middle cranial fossa with left internal carotid artery encasement. Endoscopic biopsy via transnasal sphenoidotomy was performed under general anesthesia, and an easy fragile, yellowish, reddish mass in the sphenoid sinus was partially removed. The mass had infiltrated into the lateral, inferior and superior wall of the left sphenoid sinus. Biopsy confirmed a diffused large B-cell lymphoma. First, the patient received gamma knife radiosurgery, followed by chemotherapy (rituximab, cyclophosphamide, adriamycin, vincristine, prednisolone). He has been in complete remission state for eight months after combination therapy.
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