[Analysis of clinical characteristics and delays in diagnosis of the lymphoma of sinonasal cavities].

Objective:To identify factors leading to delayed diagnosis of nasal cavity and paranasal sinus lymphoma （NSL） and to propose preventive strategies. Methods:A retrospective analysis of clinical data from 36 patients with lymphoma of sinonasal cavities admitted to the Otolaryngology Department of the First Affiliated Hospital of Nanjing Medical University from January 2016 to December 2024 was conducted. Results:Among 36 patients with non-Hodgkin's lymphoma（NHL）, the most common type was extranodal NK/T-cell lymphoma（ENKTL） in 23 cases（63.8%）, with a delayed diagnosis in 16 cases（69.6%）. The second most common type was diffuse large B-cell lymphoma（DLBCL） in 8 cases（22.2%）, with a delayed diagnosis in 5 cases（62.5%）. The main clinical presentation of ENKTL was nasal obstruction（87.0%）, primarily affecting the inferior turbinate（60.9%） and nasal septum（30.4%）. Endoscopic findings included neoplasms（65.2%）, extensive mucosal erosion and necrosis（17.4%）, and local scabbing/erosion/swelling（17.4%）. Patients in the local scabbing/erosion/swelling group had significantly longer intervals from onset to diagnosis than those in the neoplasms group（P<0.05）. MRI considered lymphoma in 7 cases（46.7%）, significantly higher than CT, which considered lymphoma in 2 cases（9.5%）（P<0.05）. Pathology often revealed lymphoid hyperplasia/infiltration with atypia and necrosis（79.4%）. Common initial misdiagnoses for delayed patients included rhinitis and sinusitis（50.0%）. For DLBCL, the most common clinical symptoms included ocular symptoms（50.0%）, nasal obstruction（50.0%）, and facial pain/swelling（50.0%）, with lesions primarily in the ethmoid sinus（75.0%）, orbit（50.0%）, and maxillary sinus（37.5%）. Endoscopy primarily revealed neoplasms（62.5%）. CT and MRI suggested lymphoma/malignant tumors to be 62.5% and 71.4%, respectively. Pathological findings frequently indicated intermediate to large cell diffuse infiltration and are often misdiagnosed as facial infections（40.0%） for delayed patients. Conclusion:Nasal cavity and sinus lymphoma, primarily ENKTL and DLBCL, often face delayed diagnosis. For ENKTL, clinicians should focus on patients with local crusting/erosion/swelling, combining CT and MRI for comprehensive assessment and timely tissue biopsy. For DLBCL, imaging examinations should be prioritized. Future research should focus on developing early screening and diagnostic tools to enhance efficiency.