J Rhinol.  2015 Nov;22(2):107-111. 10.18787/jr.2015.22.2.107.

A Case of Nasal Extranodal NK/T Cell Lymphoma Misdiagnosed as Reccurent Periorbital Cellulitis or Acute Dacryocystitis

• Yang SK
• Shin DB
• Lee JO
• Lee TH

• KMID: 2223206
• DOI: http://doi.org/10.18787/jr.2015.22.2.107

Abstract

Nasal extranodal natural killer/T cell (NK/T cell) lymphoma is more common in East Asia than in the United States, comprising up to 7-10% of all non-Hodgkin's lymphoma. Early nasal symptoms are nonspecific and similar to chronic rhinosinusitis, such as nasal obstruction and nasal bleeding. With disease progression, inflammation and necrosis of the mucosa increase, hindering pathologic diagnosis. We experienced a case of nasal extranodal NK/T cell lymphoma in a 58-year-old woman who presented with recurrent periorbital swelling.

Keyword

Lymphoma; Non-Hodgkin's lymphoma; Nasal extranodal

MeSH Terms

Cellulitis*
Dacryocystitis*
Diagnosis
Disease Progression
Epistaxis
Far East
Female
Humans
Inflammation
Lymphoma*
Lymphoma, Non-Hodgkin
Middle Aged
Mucous Membrane
Nasal Obstruction
Necrosis
United States

Figure

• 

  Fig. 1. Coronal, enhanced, Orbit CT findings. CT scan reveal the right periorbital swelling (A) and soft tissue density on the right sinonasal cavity (B), and nodular calcifications located centrally in the right maxillary sinus (C).

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  Fig. 2. Coronal, enhanced, PNS CT findings and endoscopic finding. The images show a infiltrative lesion with mild enhancement in the left lacrimal sac and medial canthal tendon (A), and soft tissue density in anterior ethmoid sinus and both maxillary sinus (B and C). During the second surgery, biopsy was performed at the polypoid mucosa in ethmoid sinus of the left nasal cavity (D).

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  Fig. 3. Coronal, enhanced, Orbit CT findings and endoscopic finding. The images show a large infiltrative region with enhancement in the left lacrimal sac (A), soft tissue density in anterior ethmoid sinus (B), and the homogenous small mass in ethmoid sinus of the left nasal cavity (C). A endoscopic finding shows an intranasal granulomatous mass in ethmoid sinus of the left nasal cavity (D), and third biopsy was performed.

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  Fig. 4. Histologic and immunohistochemical findings. Small to medium sized atypical lymphoid cells with clear cytoplasm (HE ×100, ×400) (A and B). Tumor cells are positive for anti-CD3 and anti-CD56 antibody (×200)(C, D). Tumor cells are negative for anti-CD20 antibody (×200)(E). Tumor cells are positive for EBV-ISH (×200)(F).

Reference

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