Extranodal Natural Killer/T-cell Lymphoma in a Child with a Prior History of Nasal Trauma: a Case Report
Introduction: Facial lesions usually have a benign self-limited prognosis, but in rare cases they have a poor outcome. Extranodal natural killer/T-cell lymphoma (ENK/TCL) is a rare aggressive lesion presenting with a midline facial lesion that can easily be misdiagnosed. Diagnosis is often difficult and requires a thorough clinical examination and the use of immunohistochemistry for analysis of biopsies. Such malignancies affecting the head and neck area provide an interesting but difficult diagnosis. The purpose of this article is to report a severe case of ENK/TCL-nasal type in a boy with a previous history of nasal trauma. Case presentation: An 11-year-old boy was referred to the maxillofacial unit of Sulaimany Teaching Hospital, Iraq, with midline facial destruction. The patient stated that about 6 months prior he had fallen down and suffered nasal trauma; 3 months after the trauma, an asymptomatic ulcer appeared and gradually increased in size. Two biopsies were performed with no conclusive results. In the third biopsy, histology showed atypical lymphoid tissue surrounded by intense necrosis. The diagnosis was confirmed by immunohistochemistry. The treatment of choice was chemotherapy followed by radiotherapy. The patient had a satisfactory response but 2 months later during chemotherapy the patient unfortunately died from a pulmonary embolism. Conclusion: Suspicious midline ulcerative lesions in the head and neck region must have ENK/TCL considered in the differential diagnosis and repeated biopsies may be necessary to confirm the diagnosis.
2. Paik YS, Liess BD, Scheidt TD, Ingram EA, Zitsch RP, 3rd. Extranodal nasal-type natural killer/T-cell lymphoma masquerading as recalcitrant sinusitis. Head & neck. 2010;32(2):268-73.
3. Swerdlow SH, Campo E, Pileri SA, Harris NL, Stein H, Siebert R, et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood. 2016;127(20):2375-90.
4. Wang ZY, Li YX, Wang H, Wang WH, Jin J, Liu YP, et al. Unfavorable prognosis of elderly patients with early-stage extranodal nasal-type NK/T-cell lymphoma. Ann Oncol. 2011;22(2):390-6.
5. Neville B, Damm D, Allen C, Bouquot J, Neville B. Hematologic Disorders. In: Neville BW, Damm DD, Allen CM, Bouquot J, editors. Oral and Maxillofacial Pathology. Third ed: Saunders Elsevier; 2009.
6. Rodrigo JP, Suarez C, Rinaldo A, Devaney KO, Carbone A, Barnes L, et al. Idiopathic midline destructive disease: fact or fiction. Oral Oncol. 2005;41(4):340-8.
7. Liang R. Advances in the management and monitoring of extranodal NK/T-cell lymphoma, nasal type. Br J Haematol. 2009;147(1):13-21.
8. Gill H, Liang RH, Tse E. Extranodal Natural-Killer/T-Cell Lymphoma, Nasal Type. Adv Hematol. 2010;2010(2010):627401.
9. Altemani A, Barbosa AC, Kulka M, Takahashi T, Endo L, Vassallo J, et al. Characteristics of nasal T/NK-cell lymphoma among Brazilians. Neoplasma. 2002;49(1):55-60.
10. Takahashi E, Asano N, Li C, Tanaka T, Shimada K, Shimada S, et al. Nodal T/NK-cell lymphoma of nasal type: a clinicopathological study of six cases. Histopathology. 2008;52(5):585-96.
11. Kim TM, Park YH, Lee SY, Kim JH, Kim DW, Im SA, et al. Local tumor invasiveness is more predictive of survival than International Prognostic Index in stage I(E)/II(E) extranodal NK/T-cell lymphoma, nasal type. Blood. 2005;106(12):3785-90.
12. Isobe K, Uno T, Tamaru J, Kawakami H, Ueno N, Wakita H, et al. Extranodal natural killer/T-cell lymphoma, nasal type: the significance of radiotherapeutic parameters. Cancer. 2006;106(3):609-15.
13. Al-Hakeem DA, Fedele S, Carlos R, Porter S. Extranodal NK/T-cell lymphoma, nasal type. Oral Oncol. 2007;43(1):4-14.
14. Mangrio SA, Dhanani R, Ikram M, Tariq MU. Lethal midline granuloma: a case report. The Egypt J Otolaryngol. 2017;33(1):131.