Extranodal NK/T cell lymphoma, nasal type is a rare, clinically aggressive, locally destructive and necrotizing disease. It represents
7-10% of all non-Hodgkin lymphomas with a 1-year survival rate of 40%. This case will be the first reported case in the Philippines.
We report 44 year old Filipino male who presented with one year history of foul smelling left nasal discharge. Physical examination
was unremarkable except for ~1 x 1 cm cavity at the soft palate. Several consult done, given nasal drops and antibiotics with
no relief of symptoms. Nasopharyngeal CT scan revealed a 5.2 x 3.1 cm soft tissue mass at left nasal cavity extending into the
contralateral nasal cavity, no intracranial extension. After three unremarkable nasal biopsies, histopathology revealed round cell
neoplasm, with immunohistochemical stains consistent with NK/T cell lymphoma Nasal type localized disease. Metastatic work up
were all unremarkable. He then underwent concurrent chemotherapy with Cisplatin and radiotherapy (30cGY). The palatal cavity
increased in size to 3 x 3 cm after completion of radiotherapy, however the soft tissue mass decreased in size hence three cycles
of VIPD (etoposide, ifosfamide, cisplatin, dexamethasone) was given. Patient remained asymptomatic, with a good performance
score. Nasal endoscopy and nasopharyngeal MRI done post-treatment showed no evidence of lesion with stable palatal cavity
defect. CT scan of chest however revealed a left upper lobe non-calcified 2cm nodule with bilateral subpleural nodules.
In a rare yet aggressive malignancy such as NK/T cell lymphoma wherein the primary lesion had good response to treatment,
a new lung lesion could impose progressive disease such as metastasis. We could either treat patient as a case of progressive
disease and subject him to a battery of chemotherapy or we could biopsy the new lesion. Either way, delay in diagnosis cause
undue anxiety and uncanny cost to patient. In our case, biopsy was done and indeed it was of infectious in origin. The malignancy
responded well to treatment.
Specific Soft-Tissue Invasion and LMP1 Expression Are Potential Indicators of Extranodal NK/T Cell Lymphoma, Nasal Type