# Subcutaneous Facial Mass as a Rare Presentation of Follicular Lymphoma: A Case Report

## TL;DR

A 68-year-old woman's facial swelling was initially thought to be allergies but was later diagnosed as a rare case of follicular lymphoma.

## Contribution

This case report highlights the rare presentation of follicular lymphoma as a subcutaneous facial mass and the diagnostic challenges involved.

## Key findings

- A facial mass was initially misdiagnosed as seasonal allergies but later found to be follicular lymphoma.
- Fine needle aspiration biopsies failed to detect malignancy, emphasizing their limitations in diagnosing soft tissue lymphomas.
- Surgical excision confirmed follicular large B-cell lymphoma, underscoring the need for clinical suspicion in unresponsive facial masses.

## Abstract

Follicular lymphoma is a common form of non-Hodgkin lymphoma. Extranodal involvement, especially in soft tissue, is rare. Here, we present a case of a 68-year-old female patient who presented with a recurrent swollen cheek, which was initially misdiagnosed as seasonal allergies. Imaging revealed a soft tissue mass, but two fine needle aspiration (FNA) biopsies were negative for malignancy. Clinical suspicion remained high and surgical excision was performed, revealing lymphoid proliferation consistent with follicular large B-cell lymphoma. Our case underscores the diagnostic challenges of soft tissue lymphomas and limitations of FNAs in ruling out malignancy. Furthermore, it highlights the necessity of maintaining clinical suspicion for lymphoma in cases of unresponsive facial masses.