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

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.