Diffuse large B-cell lymphoma of the pterygopalatine fossa with multiple cranial nerve palsies

We report a case of diffuse large B-cell lymphoma (DLBCL) of the pterygopalatine fossa (PPF) that developed with multiple cranial nerve palsies. A 70-year-old woman received steroid treatment for right facial palsy but was referred to our hospital because of additional diplopia and dysarthria. Neurological examination revealed multiple cranial nerve palsies associated with the right IV and XII and bilateral VII nerves. Computed tomography and magnetic resonance imaging showed lesions infiltrating Meckel's cavity and the cavernous sinus from the right PPF. Subsequently, right visual impairment and III and V1 cranial nerve palsies appeared; however, the right XII and left VII cranial nerve palsies improved spontaneously. A biopsy from the PPF was performed using an endoscopic transnasal approach, and the histological diagnosis was DLBCL. She was treated with chemotherapy. Although the PPF is an anatomically difficult site to access, biopsy using the endoscopic transnasal approach makes a minimally invasive diagnosis possible. Keywords: diffuse large B-cell lymphoma, endoscopic sinus surgery, malignant lymphoma, non-hodgkin lymphoma, paranasal sinus diseases