(093) CLL Masquerading as Nasal Polyps: Case Report

Introduction: Chronic lymphocytic leukemia (CLL) is a type of non-Hodgkin lymphoma that manifests as a monoclonal proliferation of incompetent mature B cells. Common symptoms of CLL include weight loss, fevers, night sweats, muscle wasting, hepatosplenomegaly, and lymphadenopathy. As the disease progresses, patients may present with signs of anemia, thrombocytopenia, and recurrent infections secondary to hypogammaglobulinemia.

Methods: This is a case of a 60-year-old female who presented to the otolaryngologist with complaints of rhinosinusitis for three months. Her past medical history was notable for a recent diagnosis of CLL and was under observation. The patient was treated with the standard of care medical treatments until failure. She underwent bilateral maxillary and sphenoid balloon sinuplasty and left frontal balloon sinuplasty, which only offered a couple of months of relief. Upon the return of symptoms, she was treated medically until failure and then a submucosal resection of the inferior turbinate (SMRT). These symptoms, and the nasal polyps, were refractory prompting further surgery, including a biopsy.

Results: The tissue samples were positive for CD5, CD20, CD23, CD43, PAX-5, BLC-2, and trisomy 12, concluding that the nasal polyps were manifestations of the SLL/CLL. The patient is currently receiving treatment for CLL.

Conclusions: To our knowledge, this is the only known case of CLL involving the sinonasal mucosa. We suspect that this patient’s chronic rhinosinusitis with polyposis represents a novel presentation of CLL which could guide earlier initiation of therapy for similar cases.