Small Lymphocytic Lymphoma/Chronic Lymphocytic Leukemia Presenting as a Nasopharyngeal Mass With Bilateral Otitis Media With Effusion: A Case Report

TL;DR

A rare case of a lymphoma/leukemia presenting as a nasopharyngeal mass and ear symptoms is reported, highlighting the need for thorough testing in similar cases.

Contribution

This case report highlights the rare ENT presentation of SLL/CLL and emphasizes the importance of biopsy and molecular testing for accurate diagnosis.

Findings

SLL/CLL can present with nasal obstruction and bilateral otitis media with effusion.

Histology and IHC confirmed the diagnosis of SLL/CLL in a patient with a nasopharyngeal mass.

Treatment with Zanubrutinib led to rapid symptom resolution.

Abstract

Small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL) is an indolent B-cell malignancy that rarely involves the nasopharynx. Such cases may present with nonspecific ear, nose, and throat (ENT) symptoms, delaying diagnosis.

In this case report, we present a 54-year-old male who presented with a six-month history of nasal obstruction and bilateral hearing loss due to otitis media with effusion. Nasoendoscopy demonstrated a nasopharyngeal mass. He underwent biopsy and excision of the nasopharyngeal mass, bilateral myringotomy with grommet tube insertion, and turbinoplasty. Histology and immunohistochemistry (IHC) confirmed SLL/CLL. Positron emission tomography (PET)/ computed tomography (CT) showed cervical, axillary, and inguinal lymphadenopathy. Molecular studies found an immunoglobulin heavy chain variable mutation (IGHV) with wild-type TP53. The patient was started on Zanubrutinib 160 mg twice daily, resulting in a rapid resolution of symptoms.

SLL and CLL presenting as a nasopharyngeal mass are very rare and can be challenging for ENT experts. Adults with persistent otitis media with effusion (OME) and a nasopharyngeal mass should undergo biopsy with IHC and molecular testing to avoid underdiagnosis and ensure timely targeted therapy.

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