Adult Burkitt lymphoma originating in the sphenoid sinus: case report and review of the literature.

Burkitt lymphoma is a high-grade B-cell non-Hodgkin lymphoma. The endemic form of this malignancy occurs primarily in children aged 5 to 7 years, and it presents with jaw and facial bone involvement. The sporadic form affects older children (mean age: 12.2 yr) and often manifests as an abdominal mass; it rarely involves the head and neck. The presence of any type of lymphoma in the paranasal sinuses is rare. We report a case of Burkitt lymphoma that originated in the sphenoid sinus in a 66-year-old white woman. The patient presented with hypoesthesia in the left V1 and V2 distributions and frequent left-sided headaches. Imaging revealed that the destructive lesion had spread into the cavernous sinus and infratemporal fossa. Repeat imaging showed progression of the lesion in just 1 month. An endoscopic sphenoidotomy was performed to obtain a tissue specimen, and a diagnosis of sporadic Burkitt lymphoma was established on the basis of its clinical, morphologic, and immunohistochemical characteristics. The patient underwent chemotherapy and radiation. Short-term follow-up imaging showed that the lesion had disappeared, and the patient remained disease-free at 3 years of follow-up. This case is one of the few reported cases of true adult Burkitt lymphoma originating in the sphenoid sinus. We discuss the rapid progression of the disease and the considerable amount of invasion that can occur with minimal symptoms

Clinical consensus statement: appropriate use of computed tomography for paranasal sinus disease.

ObjectiveTo develop a consensus statement on the appropriate use of computed tomography (CT) for paranasal sinus disease.Subjects and methodsA modified Delphi method was used to refine expert opinion and reach consensus by the panel.ResultsAfter 3 full Delphi rounds, 33 items reached consensus and 16 statements were dropped because of not reaching consensus or redundancy. The statements that reached consensus were grouped into 4 categories: pediatric sinusitis, medical management, surgical planning, and complication of sinusitis or sinonasal tumor. The panel unanimously agreed with 13 of the 33 statements. In addition, at least 75% of the panel strongly agreed with 14 of 33 statements across all of the categories.ConclusionsFor children, careful consideration should be taken when performing CT imaging but is needed in the setting of treatment failures and complications, either of the pathological process itself or as a result of iatrogenic (surgical) complications. For adults, imaging is necessary in surgical planning, for treatment of medical and surgical complications, and in all aspects of the complete management of patients with sinonasal and skull base pathology

Clinical consensus statement: appropriate use of computed tomography for paranasal sinus disease.

ObjectiveTo develop a consensus statement on the appropriate use of computed tomography (CT) for paranasal sinus disease.Subjects and methodsA modified Delphi method was used to refine expert opinion and reach consensus by the panel.ResultsAfter 3 full Delphi rounds, 33 items reached consensus and 16 statements were dropped because of not reaching consensus or redundancy. The statements that reached consensus were grouped into 4 categories: pediatric sinusitis, medical management, surgical planning, and complication of sinusitis or sinonasal tumor. The panel unanimously agreed with 13 of the 33 statements. In addition, at least 75% of the panel strongly agreed with 14 of 33 statements across all of the categories.ConclusionsFor children, careful consideration should be taken when performing CT imaging but is needed in the setting of treatment failures and complications, either of the pathological process itself or as a result of iatrogenic (surgical) complications. For adults, imaging is necessary in surgical planning, for treatment of medical and surgical complications, and in all aspects of the complete management of patients with sinonasal and skull base pathology

ACR Appropriateness Criteria ® Sinusitis-Child

Sinusitis is common in children that usually resolves spontaneously. Imaging is not part of the standard of care for initial diagnosis, however may be necessary in cases with persistent or chronic sinusitis to guide surgical intervention, or to rule out intracranial and vascular complications of sinusitis. Computed tomography (CT) and magnetic resonance imaging (MRI) are the leading imaging modalities. In this article, appropriateness in use of imaging modalities are discussed under common/clinically relevant scenarios. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment

ACR Appropriateness Criteria

Sinusitis is common in children that usually resolves spontaneously. Imaging is not part of the standard of care for initial diagnosis, however may be necessary in cases with persistent or chronic sinusitis to guide surgical intervention, or to rule out intracranial and vascular complications of sinusitis. Computed tomography (CT) and magnetic resonance imaging (MRI) are the leading imaging modalities. In this article, appropriateness in use of imaging modalities are discussed under common/clinically relevant scenarios. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment