Unusual Nasopharyngeal Localization of Chronic Lymphocytic Leukemia: A Case Report.

Chronic lymphocytic leukemia (CLL) is a common B-cell malignancy that typically involves the peripheral blood, bone marrow, and lymphoid tissues, whereas extranodal involvement remains rare. Nasopharyngeal localization is exceptionally uncommon and may mimic primary head and neck tumors, leading to diagnostic challenges. We report the case of a 64-year-old man presenting with progressive left-sided nasal obstruction. Clinical examination revealed bilateral cervical lymphadenopathy and splenomegaly. Imaging studies demonstrated a well-defined mass occupying the posterosuperior wall of the nasopharynx, involving the Rosenmüller fossae and Eustachian tube orifices, without bone invasion. Histopathological examination showed a dense infiltration of small, monomorphic lymphocytes, and immunohistochemistry was positive for CD20, CD5, CD23, and Bcl-2. Peripheral blood lymphocytosis with a Matutes score of 5/5 confirmed the diagnosis of CLL, and cytogenetic analysis showed no deletion of 17p (p53). The patient was treated with six cycles of rituximab-bendamustine, resulting in complete regression of the nasopharyngeal mass and reduction in splenomegaly, with minimal residual lymphadenopathy and good clinical and biological tolerance. This case highlights the importance of considering CLL in the differential diagnosis of nasopharyngeal masses and emphasizes the role of combined imaging, histology, and immunophenotyping in establishing an accurate diagnosis and guiding appropriate management.