When Snoring isn't just Snoring: Primary Nasopharyngeal Mantle Cell Lymphoma - A Rare Pathology in the Nasopharynx.

Snoring is a common complaint in the primary care and otolaryngology clinic with a wide differential diagnosis. Primary nasopharyngeal mantle cell lymphoma is a rare cause of a nasopharyngeal mass, which can commonly manifest as snoring. The patient in this case presented with extensive history of recent worsening snoring as well as nasal congestion over the past several months. Additionally, the patient had previously undergone endoscopic sinus surgery several years prior but was lost to follow up. During nasal endoscopy, a nasopharyngeal mass was visualized with near-complete obstruction of the nasal airway. Intraoperative biopsies indicated MCL which is an uncommon pathology presenting in a rare location. Flow cytometry of the biopsy specimen was CD19+, CD20+, CD5+, and positive for lambda light chains with immunohistochemistry showed strong diffuse cyclin D1 nuclear staining on lymphoid cells. PET/CT and bone marrow biopsy were essential in staging disease, predicting success of treatment, and determining optimal treatment planning. Once the diagnosis was established, R-CHOP therapy alternating with R-DHAP for a total of six cycles. This case report highlights the importance of recognizing new or changing symptoms, appropriate diagnostic workup for lymphoma, as well as one of few case reports describing primary nasopharyngeal mantle cell lymphoma.

Correlation of Clinical Factors and Audiometric Characteristics with MRI Findings in Patients with Asymmetric Sensorineural Hearing Loss.

CONTEXT: To identify the presence of any correlative factors between presenting symptoms and characteristics of asymmetrical sensorineural hearing loss on audiogram, and if retrocochlear pathology was identified on MRI in patients presenting in a private practice setting. METHODS: A retrospective study of patients meeting inclusion criteria who underwent MRI for asymmetric hearing loss between March 2014 to March 2017 was reviewed using Allscripts electronic health records. This data was then compiled in an excel spreadsheet and submitted for statistical analysis. RESULTS: Of the initial 687 study patients, N = 303 patients met the inclusion criteria for review. Of these 303, 48 patients (15.8%) had abnormal MRI findings. Chi-square analysis performed showed no significant association of varied clinical variables (e.g. uni and bi-lateral tinnitus, vertigo, etc.) with abnormal MRI. Point Biserial Correlation analysis revealed no statistically significant correlations, with the exception of that between AS (Left Ear) 6 kHz and MRI lesions (r = -0.115, p = 0.045). Logistic and multinomial logistic regression analysis used to calculate odds ratios showed that for patients with hearing loss at the 6 kHz (dB) level, there is a very slightly lower, statistically significant likelihood of lesions showing up on MRI (OR, 0.984 (95% CI, 0.970-0.998), p = 0.0251). CONCLUSIONS: The results lead to the conclusion that there may be an association between experiencing hearing loss at the level of 6 kHz and a slightly lower chance of the presence of retrocochlear lesion noted on MRI.