Primary nasopharyngeal germinal center Diffuse Large B Cell Lymphoma (DLBCL) presenting with multiple cranial neuropathies and skull base invasion: A case report

Primary nasopharyngeal lymphoma is an uncommon manifestation of extra-nodal non-Hodgkin lymphoma. Additionally, diffuse large B-cell lymphoma (DLBCL) of germinal center origin in this location is exceptionally rare. Here, we report a case of a 60-year-old male presenting with bilateral nasal obstruction, blood-stained discharge, and left-sided ptosis, associated with oculomotor, abducens, and trigeminal nerve palsies. Imaging demonstrated a destructive nasopharyngeal mass with skull base erosion and intracranial erosion without nodal or systemic disease. Histopathology showed sheets of atypical lymphoid cells positive for CD20, CD10, BCL6, and c-MYC, consistent with high-grade germinal center DLBCL. After receiving two cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone), the patient showed remarkable neurological improvement. To the best of our knowledge, this is the first case in Pakistan of primary nasopharyngeal germinal center DLBCL with multiple cranial neuropathies and skull base invasion. This case underscores the importance of considering lymphoma as a differential in nasopharyngeal masses with cranial nerve involvement. This case demonstrates that prompt histological diagnosis and timely chemotherapy can achieve favorable outcomes, even in cases with extensive local invasion but no systemic spread.