Acute lymphoblastic leukemia (ALL) primarily affects the bone marrow and peripheral blood.Extramedullary manifestations, especially in the sinonasal cavity, are rare and difficult to diagnose.We report a case of B-cell ALL in a 4-year-old girl who initially presented with a sinonasal mass mimicking a primary malignant neoplasm.The patient developed right eye protrusion upon nasal blowing over a period of 2 weeks.Imaging studies revealed an aggressive-appearing mass in the right maxillary sinus with extensive local invasion.The radiologic differential diagnosis included rhabdomyosarcoma, lymphoma, and other pediatric sinonasal malignancies.Histopathologic examination of the biopsy specimen and subsequent bone marrow evaluation established the diagnosis of B-cell ALL with BCR/ABL1 fusion.This case highlights the importance of including ALL in the differential diagnosis of sinonasal masses in pediatric patients, particularly when imaging features suggest an aggressive malignancy accompanied by hematologic abnormalities.A comprehensive evaluation, including imaging studies, routine laboratory tests, tissue biopsy, and bone marrow examination, is crucial for establishing an accurate diagnosis and initiating appropriate treatment.
Koh et al. (Thu,) studied this question.