Delayed diagnosis of nasal natural killer/t-cell lymphoma

Abstract

Midline destructive lesions of the face have multiple possible etiologies. The majority of these cases are found to be due to an extranodal lymphoma of natural killer/T-cell-type non-Hodgkins lymphoma (NKTL). Unfortunately, diagnosis is often delayed. With variable presenting complaints, including nonspecific issues like chronic rhinosinusitis or nasal congestion, initial treatments are aimed at these presumed diagnoses. Only as the lesion progresses do overt signs of destruction occur. As with our patient, who was initially treated for presumed infection and abscess, final diagnosis often does not occur until several months, and several antibiotic courses, from initial presentation. As such, it is important for this rare entity to remain in the clinician's differential diagnosis for nasal lesion.

Figure 1

Coronal contrast enhanced CT scan showing large subcutaneous soft tissue density lesion of the nasal ala.

Figure 2

Axial contrast enhanced CT scan redemonstrating subcutaneous nasal lesion.

Figure 3

Axial MRI T2 FLAIR image of the nasal lesion with relatively homogeneous, low intensity signal.

Figure 4

Epstein-Barr virus encoded ribonucleic acid (EBER) in situ hybridization showed strong nuclear staining in the majority of cells. Inset is area of higher magnification.