A Diagnostic Dilemma of Sinonasal T Cell Lymphoma: Report of A Unique Case and Literature Review.Gulf J Oncolog 2019; 1(31):83-89GJ
Natural Killer/T-cell non-Hodgkin lymphomas are rare and aggressive disease of non-Hodgkin lymphoma characterized by angioinvasion, angiodestruction and necrosis. It has a strong association with Epstein-Barr virus (EBV) as the lymphoma cells are almost invariably infected with the clonal episomal form of EBV. Because of their rarity, it is a challenge to diagnose and treat them even to the experienced pathologists.
The featured case describes a 40-year-old male who presented with symptoms suggestive for sinusitis. Further diagnostic investigation by the functional endoscopic sinus surgery (FESS) revealed a chronic sinusitis with multiple biopsies showing negative for malignancy, viral and bacterial infections and therefore undiagnosed for sinonasal NK/T-cell lymphoma. Subsequently after a month of surgery, he developed multiple lymph nodes in inguinal where biopsy revealed extranodal NK/T-cell non-Hodgkin lymphoma, high grade but in no time for treatment, he finally succumbed to the illness.
The case presented here was initially diagnosed as a chronic sinusitis, not as sinonasal NK/Tcell lymphoma which later developed into extranodal NK/T-cell lymphoma. The prognosis showed improvement for nasal lymphomas but remains poor for disseminated and extranasal lymphomas which are more aggressive with lower survival rate. It is clinically important to differentiate diseases for proper staging and monitoring as they require completely different treatment strategies.