Extranodal nasal-type natural killer/T-cell lymphoma masquerading as recalcitrant sinusitis.
BACKGROUND
Extranodal nasal-type natural killer (NK)/T-cell lymphoma is a very uncommon disease process often mimicking refractory sinusitis. The diagnosis may be discovered after an extensive exclusion process. Careful immunohistochemical evaluation is crucial to differentiate NK/T-cell lymphoma from other malignancies.


RESULTS
We describe a 46-year-old white man presenting with a 4-month history of refractory sinusitis and new onset visual field loss in his right eye, right facial tingling, and pain. Examination revealed right periorbital edema and scleritis, and necrotic appearing turbinates with purulence and fibrinous debris. CT/MRI delineated extensive paranasal sinus involvement. Immunohistopathology demonstrated extranodal nasal-type NK/T-cell lymphoma. Additional radiography revealed widespread involvement.


CONCLUSIONS
Severe recalcitrant sinusitis with orbital involvement may be the initial presentation of NK/T-cell lymphoma. Ulcerative or necrotic lesions in the midline of the head and neck should raise concern for this disease. In addition to radiographic and laboratory testing, large biopsies should be taken for immunohistochemical analysis to achieve diagnosis and guide further management.
Department of Otolaryngology-Head and Neck Surgery, University of Missouri-School of Medicine, Columbia, Missouri, USA.
Young S
YS
Paik
Benjamin D
BD
Liess
Troy D
TD
Scheidt
Ellis A
EA
Ingram
Robert P
RP
Zitsch
D003937:Diagnosis, Differential; D005157:Facial Pain / Q000209:etiology; D005158:Facial Paralysis / Q000209:etiology; D017809:Fatal Outcome; D006314:Hearing Loss, Conductive / Q000209:etiology; D006801:Humans; D054391:Lymphoma, Extranodal NK-T-Cell / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D012852:Sinusitis / Q000175:diagnosis; D014057:Tomography, X-Ray Computed; D014786:Vision Disorders / Q000209:etiology; D014794:Visual Fields