title: Mediastinal single nodal relapse of a nasal NK/T cell lymphoma.
abstract: A nasal NK/T cell lymphoma is a very aggressive form of lymphoma. Patterns of relapse after treatment have not been systematically evaluated, and mediastinal nodal relapse at a primary site has never been documented. We describe here a 40-year old man who presented with a nasal obstruction caused by a protruding mass that was identified as a nasal NK/T cell lymphoma. The initial work-up, including chest and abdominopelvic computed tomography (CT) and positron emission tomography (PET), showed no regional or distant metastasis. A CT scan performed following three cycles of chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) showed that the mass had nearly disappeared. Radiation therapy undertaken following chemotherapy was given to the primary site. However, PET performed following radiotherapy revealed a single mediastinal lymphadenopathy, with no evidence of residual tumor in the nasal cavity. A biopsy using video-assisted thoracoscopy (VATS) showed the presence of a recurrent NK/T cell lymphoma with an immunophenotype identical to that of the primary nasal lymphoma. An additional three cycles of CHOP chemotherapy were administered, and the patient remains alive, with no evidence of disease 30 months after the initial relapse. These findings indicate that early detection with PET and prompt surgical excision with the use of VATS can lead to successful treatment of a relapsed nasal NK/T cell lymphoma.
authors.affiliation: Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Kyoung Hoon
authors.initials: KH
authors.lastname: Rhee
authors.forename: Seok Chan
authors.initials: SC
authors.lastname: Hong
authors.forename: Jeong Min
authors.initials: JM
authors.lastname: An
authors.forename: Jooryung
authors.initials: J
authors.lastname: Huh
authors.forename: Ryu Jin
authors.initials: RJ
authors.lastname: Sook
authors.forename: Jin Seong
authors.initials: JS
authors.lastname: Lee
authors.forename: Cheolwon
authors.initials: C
authors.lastname: Suh
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D006801:Humans; D008207:Lymphatic Metastasis; D054391:Lymphoma, Extranodal NK-T-Cell / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D009669:Nose Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D049268:Positron-Emission Tomography; D011239:Prednisolone / Q000008:administration & dosage; D018714:Radiotherapy, Adjuvant; D014057:Tomography, X-Ray Computed; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone