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Extranodal natural killer/t-cell lymphoma - nasal type - `midline lethal granuloma` - a case report

Simona Nizorkova, Yavor Hinov, Irini Karatsoli, Sezgin Syuli, Svetlana Gercheva


Introduction: The numerous lymphoid neoplasms vary widely in their clinical presentation and behaviour, and thus all present challenges to clinicians. Approximately 0.17 - 1.5% of all Non Hodgkin`s lymphomas (NHL) are with a fractional amount involving the nasal cavity and paranasal sinuses. NHL nasal type is rare and aggressive. It typically causes local destructive midfacial necrotizing lesions, damaging of cartilage, bone and soft tissues. However, extranodal type of NHL is hard to recognize and treat.

Materials and methods: A 70-year old female patient was admitted to the the `St. Marina`, University Hospital, Varna complaining of recurrent episodes of nasal infections and night sweating.

Results: A physical examination reveals a palpable mass on the right side of the nasal cavity that caused partial nasal obstruction, breathing problems. In addition to that, splenomegaly (140/56mm) was found. An extended parenchymal structure infiltrating the underlying soft tissues of the right ala nasi 75/23mm in size was found during a computed tomography scan. Differential diagnosis between neuroblastoma and lymphoma was considered after performing a biopsy. Subsequent immunohistochemical tests and trephine biopsy confirm the diagnosis to be Extranodal NHL. The patient was admitted to the Haematology Department for chemotherapy with regime CHOEP - Vincristine, Etoposide, Endoxan, Episindan and Prednisolone. Haematological partial response was achieved after only three cycles of the therapy. The treatment was followed up by radiotherapy.

Conclusion: Non Hodgkin`s Lymphoma nasal type is considered as a fast progressing, nonrelenting tumor. Its ambiguous symptoms and the difficulties of obtaining a histological diagnosis result in postponement of the initial therapy. Despite that, advancements in immunohistochemistry help in achieving admirable results.


lymphoma, nasal, oncohaematology



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