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Wu Y, Zhang Y, Li C, Xie Y, Jiang S, Jiang Y, Qiu Y, Luo X, Chen Q. Follicular lymphoma manifests as multiple erosive and proliferative lesions of the oral mucosa: case report and brief literature review. BMC Oral Health 2022; 22:514. [PMCID: PMC9675221 DOI: 10.1186/s12903-022-02567-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 11/05/2022] [Indexed: 11/21/2022] Open
Abstract
Background Erosion is one of the most common and basic lesions of oral mucosal diseases. Long-term refractory oral erosions, induced by autoimmune blistering diseases, infectious diseases, malignant diseases, and some rare conditions, may substantially reduce the quality of life of patients or even constitute a life-threatening condition, resulting in a clinical dilemma regarding the accurate diagnosis and precise management of these diseases. As a special type of malignant lymphoma, most lesions of follicular lymphoma (FL) in the oral mucosa present as masses or swelling of the oral mucosa, while emerging novel presentations lead to intractable diagnoses. Hence, diagnostic algorithms for such diseases are clinically required. Case presentation A 55-year-old female patient presented to the clinic with long-lasting oral mucosal erosions and proliferative lesions. Blood tests, pathological examinations of oral lesions including haematoxylin–eosin (HE) staining, and direct immunofluorescence precluded all of the potential diagnoses described previously. Unexpectedly, positron emission tomography/computed tomography (PET/CT) and abdominal CT of the patient revealed a dense mass in the retroperitoneal area, and the final diagnosis of the retroperitoneal mass was FL. After three courses of chemotherapy conducted by the haematologist, the erosion and proliferative lesions in the patient's oral mucosa had significantly improved. HE and immunohistochemical staining results of intraoral lesions also confirmed it as oral FL. The successful diagnosis of FL in this case is of great clinical significance, as the oral and abdominal FL were treated in a timely manner to avoid unfavourable outcomes. Conclusions To the best of our knowledge, this is the first case of FL that exhibited widespread erosions interspersed with proliferative lesions. Clinicians should be aware of oral FL or seek systemic factors in the presence of similar refractory oral erosions when treatment is non-responsive and the diagnosis is intractable.
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Affiliation(s)
- Yuqi Wu
- grid.13291.380000 0001 0807 1581State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, 610041 Chengdu, China
| | - You Zhang
- grid.13291.380000 0001 0807 1581State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, 610041 Chengdu, China
| | - Chunyu Li
- grid.13291.380000 0001 0807 1581State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, 610041 Chengdu, China
| | - Yulang Xie
- grid.13291.380000 0001 0807 1581State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, 610041 Chengdu, China
| | - Sixin Jiang
- grid.13291.380000 0001 0807 1581State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, 610041 Chengdu, China
| | - Yuchen Jiang
- grid.13291.380000 0001 0807 1581State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, 610041 Chengdu, China
| | - Yan Qiu
- grid.412901.f0000 0004 1770 1022Department of Pathology, West China Hospital, Sichuan University, Chengdu, 610041 China
| | - Xiaobo Luo
- grid.13291.380000 0001 0807 1581State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, 610041 Chengdu, China
| | - Qianming Chen
- grid.13291.380000 0001 0807 1581State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, 610041 Chengdu, China
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Difficult and complicated oral ulceration: an expert consensus guideline for diagnosis. Int J Oral Sci 2022; 14:28. [PMID: 35650189 PMCID: PMC9160262 DOI: 10.1038/s41368-022-00178-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/01/2022] [Accepted: 04/18/2022] [Indexed: 02/05/2023] Open
Abstract
The complexity of oral ulcerations poses considerable diagnostic and therapeutic challenges to oral specialists. The expert consensus was conducted to summarize the diagnostic work-up for difficult and complicated oral ulcers, based on factors such as detailed clinical medical history inquiry, histopathological examination, and ulceration-related systemic diseases screening. Not only it can provide a standardized procedure of oral ulceration, but also it can improve the diagnostic efficiency, in order to avoid misdiagnosis and missed diagnosis.
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Suenaga H, Iikubo M, Tamahara T, Dodo M, Peck C, Koseki T, Harigae H, Sasaki K. Dental care using an oral appliance to support hematopoietic stem cell transplantation for NK/T cell lymphoma, nasal type, with palatal perforation. J Prosthodont Res 2021; 66:353-356. [PMID: 34261847 DOI: 10.2186/jpr.jpr_d_20_00270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PATIENT A 33-year-old man diagnosed with extranodal natural killer cell/T-cell lymphoma, nasal type (ENKTCL-NT) inducing palatal perforation was referred to the perioperative oral care support center of Tohoku University Hospital for dental care to support cancer treatment including chemotherapy and hematopoietic stem cell transplantation (HSCT). Dental review during chemotherapy revealed mucositis suspected to be caused by mucosal trauma from altered jaw function (chewing and speech) due to palatal perforation. Although the patient was already in the cleanroom, an oral appliance as well as conservative care as recommended in oral management guidelines for HSCT were used to prevent worsening of oral mucositis at subsequent HSCT including High-dose chemotherapy and total body irradiation. After HSCT, a prosthodontist fitted a palatal obturator made by a dental technician and an oral surgeon reviewed the necrotic bone and removed the sequestra according to the changes in the palate. This approach involving a multidisciplinary team including a hematologist improved the impaired oral function and minimized oral complications . DISCUSSION ENKTCL-NT and its treatment have a significant impact on patients' oral status. Hence, it is important to provide customized dental care based on previously endorsed guidelines according to the type of disease, treatment requirements, and oral and systemic status. CONCLUSIONS This report indicated the importance of dental care with a customized plan before, during, and after HSCT for ENKTCL-NT with multidisciplinary supportive care for cancer patients to improve the impaired oral function and to minimize oral complications.
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Affiliation(s)
- Hanako Suenaga
- Discipline of Oral Health, School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Westmead.,Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, Sendai
| | - Masahiro Iikubo
- Division of Dental Informatics and Radiology, Tohoku University Graduate School of Dentistry, Sendai.,Perioperative Oral Care Support Center, Tohoku University Hospital, Sendai
| | - Toru Tamahara
- Department of Community Medical Supports, Tohoku Medical Megabank Organization, Tohoku University, Sendai
| | - Mina Dodo
- Division of Preventive Dentistry, Tohoku University Graduate School of Dentistry, Sendai
| | - Chris Peck
- Faculty of Medicine and Health, The University of Sydney, Westmead
| | - Takeyoshi Koseki
- Division of Preventive Dentistry, Tohoku University Graduate School of Dentistry, Sendai
| | - Hideo Harigae
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Sendai
| | - Keiichi Sasaki
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, Sendai
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Andreou A, Thermos G, Sklavounou-Andrikopoulou A. Extranodal NK/T Cell Lymphoma, Nasal Type with Palatal Involvement: A Rare Case Report and Literature Review. Head Neck Pathol 2020; 15:621-627. [PMID: 32588215 PMCID: PMC8134638 DOI: 10.1007/s12105-020-01182-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/28/2020] [Indexed: 02/06/2023]
Abstract
T-cell lymphomas are infrequently encountered in the head and neck area, with the most common subtype being Extranodal NK/T cell lymphoma, nasal type (ENKTL-NT). ENKTL-NT shows a predilection for midline facial structures presenting with ulcerative destructive lesions, whereas palatal involvement is one of the most prominent signs from the oral cavity. Herein, we describe a case of a 76-year-old Greek man with nasal obstruction and an extensive painful necrotic ulcer with ragged borders on the left distal portion of the soft palate and palatine tonsil of 4-months duration. After an initial non-diagnostic biopsy from the nasopharynx, a second incisional biopsy from the palatal lesions was performed. Histopathology was suggestive of an angiocentric lymphoproliferative neoplasm and immunohistochemical examination and in situ hybridization for EBV RNA led to a final diagnosis of ENKTL-NT. The patient was placed under combined chemotherapy and radiotherapy and no recurrence has been noted. Additionally, a retrospective review of the cases in the English literature with an established diagnosis of ENTKL-NT between 2000 and 2019, based on the latest WHO classification of Head and Neck tumors, is performed.
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Affiliation(s)
- Anastasia Andreou
- grid.5216.00000 0001 2155 0800Department of Oral Medicine and Pathology, Department of Dentistry, School of Health Sciences, National and Kapodistrian University of Athens, 2 Thivon Street, 11527 Athens, Goudi Greece
| | - Grigorios Thermos
- grid.5216.00000 0001 2155 0800Department of Oral Medicine and Pathology, Department of Dentistry, School of Health Sciences, National and Kapodistrian University of Athens, 2 Thivon Street, 11527 Athens, Goudi Greece
| | - Alexandra Sklavounou-Andrikopoulou
- grid.5216.00000 0001 2155 0800Department of Oral Medicine and Pathology, Department of Dentistry, School of Health Sciences, National and Kapodistrian University of Athens, 2 Thivon Street, 11527 Athens, Goudi Greece
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5
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de Souza LL, Morais TMDL, Pontes HAR, de Almeida OP, de Carvalho MGF, Soares CD. Rapidly ulcerated swelling in the hard palate of a HIV-positive pregnant woman. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 131:e59-e64. [PMID: 32063512 DOI: 10.1016/j.oooo.2019.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 12/15/2019] [Accepted: 12/31/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Lucas Lacerda de Souza
- Department of Oral Pathology, João de Barros Barreto University Hospital, Federal University of Pará, Belém, Pará, Brazil
| | - Thayná Melo de Lima Morais
- Oral Diagnosis Department, Oral Pathology Area, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Hélder Antônio Rebelo Pontes
- Department of Oral Pathology, João de Barros Barreto University Hospital, Federal University of Pará, Belém, Pará, Brazil; Oral Diagnosis Department, Oral Pathology Area, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Oslei Paes de Almeida
- Oral Diagnosis Department, Oral Pathology Area, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Maria Goretti Freire de Carvalho
- Oral Diagnosis Department, Oral Pathology Area, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Ciro Dantas Soares
- Oral Diagnosis Department, Oral Pathology Area, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil.
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Extranodal Natural Killer/T-cell Lymphoma in a Child with a Prior History of Nasal Trauma: a Case Report. ADVANCED JOURNAL OF EMERGENCY MEDICINE 2018; 2:e34. [PMID: 31172097 PMCID: PMC6549206 DOI: 10.22114/ajem.v0i0.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Introduction: Facial lesions usually have a benign self-limited prognosis, but in rare cases they have a poor outcome. Extranodal natural killer/T-cell lymphoma (ENK/TCL) is a rare aggressive lesion presenting with a midline facial lesion that can easily be misdiagnosed. Diagnosis is often difficult and requires a thorough clinical examination and the use of immunohistochemistry for analysis of biopsies. Such malignancies affecting the head and neck area provide an interesting but difficult diagnosis. The purpose of this article is to report a severe case of ENK/TCL-nasal type in a boy with a previous history of nasal trauma. Case presentation: An 11-year-old boy was referred to the maxillofacial unit of Sulaimany Teaching Hospital, Iraq, with midline facial destruction. The patient stated that about 6 months prior he had fallen down and suffered nasal trauma; 3 months after the trauma, an asymptomatic ulcer appeared and gradually increased in size. Two biopsies were performed with no conclusive results. In the third biopsy, histology showed atypical lymphoid tissue surrounded by intense necrosis. The diagnosis was confirmed by immunohistochemistry. The treatment of choice was chemotherapy followed by radiotherapy. The patient had a satisfactory response but 2 months later during chemotherapy the patient unfortunately died from a pulmonary embolism. Conclusion: Suspicious midline ulcerative lesions in the head and neck region must have ENK/TCL considered in the differential diagnosis and repeated biopsies may be necessary to confirm the diagnosis.
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7
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Lanzel E, Syrbu SI, Hellstein JW, Stein KM, Welander S, Sousa Melo SL. Destructive soft tissue mass in the maxilla/maxillary sinus. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 125:510-515. [PMID: 28089462 DOI: 10.1016/j.oooo.2016.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/18/2016] [Accepted: 10/23/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Emily Lanzel
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, USA.
| | - Sergei I Syrbu
- Department of Pathology, Caver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - John W Hellstein
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, USA
| | - Kyle M Stein
- Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Iowa, Iowa City, IA, USA
| | - Sean Welander
- Division of Oral and Maxillofacial Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Saulo L Sousa Melo
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, USA
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8
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Park KG, Dhong ES, Namgoong S, Han JK, Han SK, Kim WK. Recurrent Extranodal NK/T-Cell Lymphoma Presenting as a Perforating Palatal Ulcer and Oro-Nasal Fistula. Arch Craniofac Surg 2016; 17:165-168. [PMID: 28913276 PMCID: PMC5556807 DOI: 10.7181/acfs.2016.17.3.165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/20/2016] [Accepted: 07/01/2016] [Indexed: 11/11/2022] Open
Abstract
Nasal-type extranodal natural killer/T-cell lymphoma (ENKTL) is a rare disease presenting with non-specific symptoms, typically originating in the nasal cavity, palate, or midfacial region. Oral cavity is an extremely rare site for this type of lymphoma. In this report, we present a case of palatal perforation and oro-nasal fistula as a manifestation of recurrent ENKTL. Complicated disease entity should be considered when surgeons deal with palatal perforation and oro-nasal fistula.
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Affiliation(s)
- Kang Gyun Park
- Department of Plastic and Reconstructive Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Eun Sang Dhong
- Department of Plastic and Reconstructive Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sik Namgoong
- Department of Plastic and Reconstructive Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jung Kyu Han
- Department of Plastic and Reconstructive Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seung Kyu Han
- Department of Plastic and Reconstructive Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Woo Kyung Kim
- Department of Plastic and Reconstructive Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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9
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Zhang S, Zhang YJ, Cao L, Liang J, Li ZS, Chen L, Wang W. Extranodal NK/T cell lymphoma misdiagnosed as Crohn's disease: A case report. Shijie Huaren Xiaohua Zazhi 2016; 24:3737-3742. [DOI: 10.11569/wcjd.v24.i25.3737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Extranodal NK/T cell lymphoma is a rare clinical entity. Due to the atypical clinical manifestations, extranodal NK/T cell lymphoma is easy to be misdiagnosed. Herein, we report a male patient who had been misdiagnosed with appendicitis and colon cancer with hepatic metastases at other hospitals. He was admitted to our hospital due to recurrent abdominal pain. The patient was initially diagnosed with Crohn's disease or lymphoma, after colonoscopic examination, pathological evaluation and immunohistochemical study. He was then given glucocorticoid and mesalazine treatment. However, his abdominal pain appeared again after the hormonal level was reduced. After re-biopsy and immunohistochemistry, he was finally diagnosed with extranodal NK/T-cell lymphoma. This case suggests that clinicians should raise their awareness of this disease, and it should be diagnosed using multiple means, among which repeated colonoscopic biopsy may reduce misdiagnosis and the preferred method of definite diagnosis is immunohistochemistry.
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10
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Spadigam A, Dhupar A, Syed S, Saluja TS. Diabetes, Epstein-Barr virus and extranodal natural killer/T-cell lymphoma in India: Unravelling the plausible nexus. Indian J Med Paediatr Oncol 2016; 37:6-13. [PMID: 27051150 PMCID: PMC4795379 DOI: 10.4103/0971-5851.177002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The International Diabetes Federation Diabetes Atlas estimates a staggering 590 million people affected with diabetes mellitus (DM) within the next two decades globally, of which Type 2 DM will constitute more than 90%. The associated insulin resistance, hyperinsulinemia, and hyperglycemia pose a further significant risk for developing diverse malignant neoplasms. Diabetes and malignancy are multifactorial heterogeneous diseases. The immune dysfunction secondary to Type 2 diabetes also reactivates latent infections with high morbidity and mortality rates. Epstein-Barr virus (EBV), a ubiquitous human herpes virus-4, is an oncogenic virus; its recrudescence in the immunocompromised condition activates the expression of EBV latency genes, thus immortalizing the infected cell and giving rise to lymphomas and carcinomas. Extranodal natural killer/T-cell lymphoma (ENKTCL), common in South-East Asia and Latin America; is a belligerent type of non-Hodgkin lymphoma (NHL) almost invariably associated with EBV. An analysis of articles sourced from the PubMed database and Google Scholar web resource until February 2014, suggests an increasing incidence of NHL in Asia/India and of ENKTCL in India, over the last few decades. This article reviews the epidemiological evidence linking various neoplasms with Type 2 DM and prognosticates the emergence of ENKTCL as a common lymphoreticular malignancy secondary to Type 2 diabetes, in the Indian population in the next few decades.
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Affiliation(s)
- Anita Spadigam
- Department of Oral and Maxillofacial Pathology, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Anita Dhupar
- Department of Oral and Maxillofacial Pathology, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Shaheen Syed
- Department of Oral and Maxillofacial Pathology, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Tajindra Singh Saluja
- Department of Oral and Maxillofacial Pathology, Goa Dental College and Hospital, Bambolim, Goa, India
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An unusual presentation of NK/T-cell lymphoma, nasal-type in the United States. Am J Otolaryngol 2015; 36:80-3. [PMID: 25304998 DOI: 10.1016/j.amjoto.2014.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 07/18/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION NK/T-cell lymphoma (NKCL), nasal-type is rare in the United States, representing only 1.5% of non-Hodgkin lymphomas. Classically, patients initially present with nasal obstruction (70%), caused by invasion of the localized lesion into the sinuses and nasal cavities. Initial presentation with persistent sore throat and odynophagia due to oropharyngeal tumor extension is rare, and thus, is often overlooked as viral or bacterial pharyngitis. By studying a case of NKTCL nasal type, we emphasize the need to apply high clinical suspicion for NKTCL, nasal type for early diagnosis and improved survival. METHODS A case report of a rare presentation of NKTCL, nasal-type is discussed. A literature review is provided to define clinical signs crucial for early diagnosis, appropriate work-up, and expedient treatment of this aggressive, rapidly progressive malignancy. RESULTS In the present case, a 25year-old healthy male presented with a 2-week history of sore throat and odynophagia. On exam, the patient had an ulcerative lesion of the soft palate, an enlarged uvula, and tonsillar exudate with tender submandibular lymphadenopathy. After the patient failed to respond to antibiotic therapy for presumptive pharyngitis, a biopsy of the oropharyngeal tissue was completed, which identified necrotizing sialometaplasia. High clinical suspicion led to repeat deep-tissue biopsy, where a final diagnosis of NKTCL, nasal type was made. The patient then began definitive treatment with chemotherapy and radiation. CONCLUSIONS High clinical suspicion is key to early diagnosis and improved survival of NKTCL, nasal-type. Otolaryngologists who encounter prolonged, complicated cases of pharyngitis or necrotizing sialometaplasia should consider a diagnosis of NKTCL, nasal-type, in order to prevent rapid disease progression.
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The spectrum of primary mucosal CD30-positive T-cell lymphoproliferative disorders of the head and neck. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 117:96-104. [PMID: 24332333 DOI: 10.1016/j.oooo.2013.10.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 09/24/2013] [Accepted: 10/03/2013] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To retrospectively investigate the clinicopathologic spectrum of primary mucosal CD30-positive T-cell lymphoproliferative disorders (PTCLDs) of the head and neck. STUDY DESIGN Archives of PTCLDs primarily arising in head and neck mucosa were reviewed. Immunostaining of CD20, CD3, CD4, CD8, CD30, CD56, anaplastic lymphoma kinase (ALK), epithelial membrane antigen (EMA), cytotoxic molecules (TIA-1, granzyme B, or perforin), and Ki67; in situ hybridization for Epstein-Barr virus; and T-cell receptor gene rearrangement analysis were performed. RESULTS Fourteen cases of primary mucosal anaplastic large cell lymphoma (M-ALCL) were identified, and no lymphomatoid papulosis (LyP) cases were found. All cases demonstrated atypical mononuclear neoplastic cells with diverse histology and cytomorphology. The typical immunophenotype of neoplastic cells was CD3-positive, CD4-positive, CD8-negative, CD30-positive, ALK-negative, and cytotoxic molecules-positive. Infiltration of inflammatory cells was common. All cases presented an indolent course, regardless of therapy. CONCLUSIONS PTCLDs of the head and neck provisionally included M-ALCL alone.
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Pontes HAR, Pontes FSC, Silva BSDF, Fonseca FP, Andrade BABD, Rizo VHT, Romanach MJ, Leon JE, Almeida OPD. Extranodal Nasal NK/T-Cell Lymphoma: A Rare Oral Presentation and FASN, CD44 and GLUT-1 Expression. Braz Dent J 2013; 24:284-8. [DOI: 10.1590/0103-6440201302202] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 05/17/2013] [Indexed: 01/05/2023] Open
Abstract
Extranodal natural killer (NK)/T-cell lymphoma is an aggressive malignant tumor with distinctive clinicopathological features, characterized by vascular invasion and destruction, prominent necrosis, cytotoxic lymphocyte phenotype and a strong association with Epstein-Barr virus. Here is reported an extranodal nasal NK/T-cell lymphoma case, involving the maxillary sinus, floor of the orbit, and interestingly extending to the oral cavity through the alveolar bone and buccal mucosa, preserving the palate, leading to a primary misdiagnosis of aggressive periodontal disease. Moreover, this work investigated for the first time the immunohistochemical expression of fatty acid synthase (FASN) and glucose transporter 1 (GLUT-1) proteins in this neoplasia. FASN showed strong cytoplasmatic expression in the neoplastic cells, whereas GLUT-1 and CD44 were negative. These findings suggest that the expression of FASN and the loss of CD44 might be involved in the pathogenesis of the extranodal nasal NK/T-cell lymphoma, and that GLUT-1 may not participate in the survival adaptation of the tumor cells to the hypoxic environment. Further studies with larger series are required to confirm these initial results.
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14
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Nikolaos N, Grigorios P, Konstantinos K, Savvas T, Vassiliki Z, Alexandra S, Theodoros P. Extranodal nasal-type NK/T-cell lymphoma of the palate and paranasal sinuses. AMERICAN JOURNAL OF CASE REPORTS 2012; 13:79-85. [PMID: 23569495 PMCID: PMC3615940 DOI: 10.12659/ajcr.882802] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 08/25/2011] [Indexed: 12/22/2022]
Abstract
Background: Extranodal nasal-type natural killer (NK)/T-cell lymphoma represents a rare entity, typically originating in the nasal cavity, palate or midfacial region. Signs and symptoms include non-specific rhinitis and/or sinusitis, nasal obstruction, epistaxis, facial swelling and development of deep necrotic ulceration in the midline of the palate, causing an oronasal defect. Differential diagnosis includes fungal infections, Wegener’s granulomatosis, tertiary syphilis, other non-Hodgkin’s lymphomas and malignant epithelial midline tumors. Case Report: We present a case of a 40-year-old man complaining of headache, facial pain, nasal congestion and fever. Examination revealed a large deep necrotic ulcer in the middle of the palate, presenting as an oronasal defect. Endoscopic rhinoscopy revealed crusts in the nasal cavities, moderate perforation of the nasal septum cartilage and contraction of the middle and inferior conchae. Computer tomography showed occupation of the maxillary sinuses, ethmoidal cells and sphenoidal sinus by a hyperdense soft tissue mass. Laboratory investigation revealed increased erythrocyte sedimentation rate. A wide excision of the lesion was performed. Histopathological and immunohistochemical evaluation established the diagnosis of extranodal nasal-type NK/T-cell lymphoma. The patient was treated with CHOP chemotherapy, involved-field radiotherapy and autologous bone marrow transplantation. A removable partial denture with obturator was fabricated and inserted to relieve problems caused by the oronasal defect. Conclusions: Extranodal nasal-type NK/T-cell lymphoma is a very aggressive, rapidly progressing malignant neoplasm with a poor prognosis, which can be improved by early diagnosis and combined treatment.
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Affiliation(s)
- Nikitakis Nikolaos
- Department of Oral Medicine and Pathology, Dental School, University of Athens, Greece
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Bhatt VR, Koirala B, Terjanian T. Extranodal natural killer/T cell lymphoma, nasal type presenting as a palatal perforation and naso-oral fistula. BMJ Case Rep 2011; 2011:2011/mar01_1/bcr1120103511. [PMID: 22707606 DOI: 10.1136/bcr.11.2010.3511] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Extranodal natural killer/T cell lymphoma (ENKL), nasal type, a rare disease presenting with vague non-specific symptoms, can impose great diagnostic difficulties and may masquerade several infectious, rheumatological or neoplastic conditions. Here, the authors report a case of ENKL presenting as a palatal perforation, naso-oral fistula and fever in a 21-year-old man, which was initially misdiagnosed as bacterial osteomyelitis, invasive fungal infection and Wegener's granulomatosis. The case report underlines the possibility of ENKL occurring at a young age, its rapidly progressive and locally destructive nature, associated diagnostic challenges and the importance of immunophenotyping in establishing the diagnosis.
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Affiliation(s)
- Vijaya Raj Bhatt
- Department of Medicine, Staten Island University Hospital, Staten Island, New York, New York, USA.
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