Extranodal NK/T cell lymphoma, nasal type is a rare aggressive, locally destructive disease. It represents 7-10% of all non-Hodgkin lymphomas with 40% 1-year survival rate. We report a 44 year old Filipino male who presented with one year history of foul smelling left nasal discharge. Physical examination was unremarkable except for ~1 x 1 cm cavity at the soft palate. Several consult were done, given nasal drops and antibiotics with no relief. Nasopharyngeal CT scan revealed a 5.2 x 3.1 cm soft tissue mass at left nasal cavity extending into the contralateral nasal cavity, no intracranial extension. After three unremarkable nasal biopsies, histopathology revealed round cell neoplasm, with immunohistochemical stains consistent with NK/T cell lymphoma Nasal type. Metastatic work up were all unremarkable. He then underwent concurrent chemotherapy with cisplatin and radiotherapy (30cGY). The palatal cavity increased in size 3 x 3 cm after completion of radiotherapy, however, the soft tissue mass decreased in size hence three cycles of etoposide, ifosfamide, cisplatin, dexamethasone were given. Patient remained asymptomatic, with a good performance status. Nasal endoscopy and nasopharyngeal MRI done post-treatment showed no evidence of lesion with stable palatal cavity defect. CT scan of chest revealed a left upper lobe non-calcified 2cm nodule with bilateral subpleural nodules.
In a rare yet aggressive malignancy such as NK/T cell lymphoma wherein the primary lesion had good response to treatment, a new lung lesion could impose progressive disease such as metastasis. We could either treat the patient as a case of progressive disease and subject him to a battery of chemotherapy or we could biopsy the new lesion. Either way, delay in diagnosis causes undue anxiety and uncanny cost to the patient. In our case, biopsy was done and indeed it was of infectious in origin. The malignancy responded well to treatment.