NK/T Cell Lymphoma, Nasal Type: a Case Report

Extranodal NK/T cell lymphoma, nasal type is a rare, clinically aggressive, locally destructive and necrotizing disease. It represents 7-10% of all non-Hodgkin lymphomas with a 1-year survival rate of 40%. This case will be the first reported case in the Philippines. We report 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 done, given nasal drops and antibiotics with no relief of symptoms. 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 localized disease. Metastatic work up were all unremarkable. He then underwent concurrent chemotherapy with Cisplatin and radiotherapy (30cGY). The palatal cavity increased in size to 3 x 3 cm after completion of radiotherapy, however the soft tissue mass decreased in size hence three cycles of VIPD (etoposide, ifosfamide, cisplatin, dexamethasone) was given. Patient remained asymptomatic, with a good performance score. Nasal endoscopy and nasopharyngeal MRI done post-treatment showed no evidence of lesion with stable palatal cavity defect. CT scan of chest however 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 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 cause undue anxiety and uncanny cost to patient. In our case, biopsy was done and indeed it was of infectious in origin. The malignancy responded well to treatment.

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Utility of F-18 FDG PET/CT for the Diagnosis and Therapeutic Management of Extranodal Natural Killer (NK)/T-Cell Lymphoma, Nasal Type

Blood ◽

10.1182/blood.v124.21.1704.1704 ◽

2014 ◽

Vol 124 (21) ◽

pp. 1704-1704

Author(s):

Bing Xu ◽

Rongwei Li ◽

Pengcheng Shi ◽

Huijuan Dong ◽

Xutao Guo ◽

...

Keyword(s):

T Cell ◽

Ct Scan ◽

Natural Killer ◽

Fdg Pet ◽

Cell Lymphoma ◽

T Cell Lymphoma ◽

Nasal Type ◽

Pet Ct ◽

Nk T Cell ◽

Fdg Pet Ct

Abstract Background: Extranodal natural killer (NK)/T-cell lymphoma, nasal type (ENKTL) is quite rare in Western populations, but relatively common in East Asia (especially China) and Latin America. ENKTL is an aggressive disease with poor prognosis, requiring risk stratification. Similar symptoms, such as nasal obstruction and purulent nasal discharge, are found in patients with nasal NKTL and in patients with chronic rhinosinusitis. The images from contrast-enhanced computed tomography (CT) frequently show no prominent mass. As a result, the diagnosis is often delayed because it is frequently misdiagnosed as sinusitis. F-18 FDG PET/CT is a powerful imaging tool for diagnosis, staging, and evaluation of therapeutic effect in oncology. Aims: This study was designed to investigate the value of FDG PET/CT in the therapeutic management of extranodal natural killer (NK)/T-cell lymphoma, nasal type. Methods: A total of 26 patients with NK/T-cell lymphoma, nasal type were diagnosed according to morphologic and immunophenotypic criteria as specified in the World Health Organization (WHO) classification. All patients underwent FDG PET/CT and clinical information was obtained by review of medical records. Results: In 26 cases, all nasal/extranasal lesions were FDG-avid evidented to be neoplasm on CT scan and histopathological examinations. FDG-avid lesions in nasal/maxillary areas were uniformly more localized than demonstrated on CT scan, suggesting soft tissue masses on CT were partly due to inflammatory reaction. Among the 26 patients with definite diagnosis, 9 patients were re-staged on the basis of F18 FDG PET/CT with 5 patients down-staged and 4 patients up-staged. Statistical difference of the standardized uptake values (SUV) after 6 courses of chemotherapy and/or radiotherapy between the complete remission (CR) group and the partial remission (PR) group can be found (4.1±2.3 versus 7.8±1.7,P=0.006). The SUV value between pre-reatment and post-treatment were also of statistical significance in 22 patients (11.4±6.2 versus 5.6±2.1,P = 0.000).At a follow up of 18 months, patients got CR had a longer survival time than those got PR, stable disease (SD) or progress disease (PD) in 20 patients out of 26 patients.(median survival:310 days vs 284 days,(95% CI: 0.7156 to 1.365, p<0.05). Conclusions: Our preliminary study suggests that FDG PET/CT can provide more accurate information on the diagnosis, staged and therapeutic response assessment in extranodal natural killer (NK)/T-cell lymphoma, nasal type. FDG PET/CT can be an invaluable imaging modality in this clinical setting. Further investigation with large patients enrollment is warranted. Disclosures No relevant conflicts of interest to declare.

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