J Rhinol.  2022 Nov;29(3):176-181. 10.18787/jr.2022.00415.

A Case of Nasal NK T-Cell Lymphoma Presenting With Persistent Epiphora

• Yun YB
• Kim YG
• Pak MG
• Kim S

• KMID: 2536588
• DOI: http://doi.org/10.18787/jr.2022.00415

Abstract

Nasal type natural killer/T-cell lymphoma (NNKTL) is a rare and aggressive subtype of non-Hodgkin lymphoma originating from a natural killer cell or γδ T cell infected by the Epstein-Barr virus. It usually invades the aerodigestive tract and can rapidly destroy the paranasal sinus, hard palate, and central nervous system. NNKTL is often mistaken for benign conditions such as chronic hypertrophic rhinosinusitis or mucosal inflammatory change, as endoscopic findings of NNKTL presenting nasal mucosal hypertrophy are similar to endoscopic findings for these abovementioned benign conditions. Here, the authors report the diagnosis and examination of NNKTL in a 58-year-old male patient who visited our clinic for nasal cavity discomfort after he underwent a dacryocystorhinostomy to treat dacryocystitis.

Keyword

Lymphoma; Extranodal NT-T-Cell; Dacryocystitis; Epiphora

Figure

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  Fig. 1. Radiologic findings. Paranasal CT shows inhomogenous enhancement and soft tissue thickening around right nasolacrimal duct (red arrowheads). A: Axial view. B: Coronal view. Paranasal CT shows mucosal thickening of right inferior turbinate and inferior meatus (white arrowheads). C: Axial view. D: Coronal view.

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  Fig. 2. Endoscopic findings. A: Shows profuse mucus discharge and swelling of right inferior turbinate adhere to right septal wall mucosa. B: Shows mucopus discharge and adhesion of right inferior turbinate to its adjacent structures. Whitish plaques are newly found on the surface of inferior turbinate. C: Shows no evidence of recurrence. There are no inflammatory change or hypertrophy of nasal mucosa.

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  Fig. 3. Radiologic findings. Paranasal CT (1 month after Fig. 1) shows nonenhanced mucosal thickening of osteomeatal unit, right maxillary sinus, base of nasal cavity and nasal septum. Thickening of mucosa remarkably progressed compared to CT 1 month ago (A: Axial view, B: Coronal view).

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  Fig. 4. Pathologic findings. A: The tumor was composed of medium-sized lymphoid cells with irregularly folded nuclei and showed angiodestructive growth pattern (arrows) (hematoxylin eosin stain, ×400 magnification). B: Tumor cells showed membranous positivity for CD56 immunohistochemical stain (CD56, ×400 magnification). C: Tumor cells were also positive for CD30 immunohistochemical stain (CD30, ×400 magnification). D: In situ hybridization for Epstein-Barr virus (EBV)-encoded small RNA (EBER) demonstrated the presence of EBV (EBER, ×400 magnification).

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  Fig. 5. Radiologic findings of positive emission tomograpy-CT. A: Hypermetabolic lymphoma in right middle meatus, middle turbinate and inferior turbinate. B: 2 month after (A) shows diffuse mild hypermetabolic mucosal thickening of right nasal cavity. Focal hypermetabolic thickening of right nasal cavity was disappeared. C: 3 month after (B). Diffuse mild hypermetabolic lesion was disappeared and there are no abnormal hypermetabolic uptake.

Reference

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