Document Type : Case Report(s)
Authors
Department of Radiation Oncology, Ramaiah Medical College and Hospitals, Ramaiah University of Applied Sciences, Bangalore, India
Abstract
Extra-nodal natural killer/T-cell lymphoma-nasal type (ENKTCL-NT) represents a rare clinical entity that often masquerades as benign lesions during its early stages, resulting in delayed diagnosis and appropriate treatment. The optimal management of this condition hinges on immunohistochemistry, disease stage, and risk stratification based on five critical prognostic factors, which encompass stage, age, performance status, lactate dehydrogenase levels, and primary tumor invasion. Radiation therapy is the cornerstone for achieving locoregional control in localized and advanced disease stages. In this case report, we present the case of a 49-year-old male, who sought medical attention at our center due to uncontrolled epistaxis following an interventional procedure for a suspected nasal polyp. Subsequent examination of histopathology slides and blocks, along with immunohistochemistry, confirmed the diagnosis of ENKTCL-NT, with residual disease evident on positron emission tomography-computed tomography. Following deliberation by the multidisciplinary tumor board, the decision was made to administer radical radiation therapy alone, with a total dose of 5940 cGy (centigray) delivered in 30 fractions employing intensity-modulated radiotherapy techniques, considering the patient's cardiac comorbidities.
Highlights
Arulponni Thiru Raju (PubMed)
Keywords
- Extra-nodal natural killer T-cell lymphoma
- Nasal polyps
- Radiotherapy
- Immunohistochemistry
- Case report
Main Subjects
How to cite this article:
Acharya AV, Arulponni TR. Diagnostic delay: Nasal polyp to extra-nodal natural killer T-cell lymphoma - A case report. Middle East J Cancer. 2024;15(3):249-54. doi:10.30476/mejc.2023.98978.1922.
- Kreisel FH. Hematolymphoid lesions of the sinonasal tract. Head Neck Pathol. 2016;10(1):109-17. doi: 10.1007/s12105-016-0698-5.
- Ohshima K, Kimura H, Yoshino T, Kim CW, Ko YH, Lee SS, et al. Proposed categorization of pathological states of EBV-associated T/natural killer-cell lymphoproliferative disorder (LPD) in children and young adults: overlap with chronic active EBV infection and infantile fulminant EBV T-LPD. Pathol Int. 2008;58(4):209-17. doi: 10.1111/j.1440-1827.2008.02213.x.
- Qi SN, Li YX, Specht L, Oguchi M, Tsang R, Ng A, et al. Modern radiation therapy for extranodal nasal-type NK/T-cell lymphoma: Risk-adapted therapy, target volume, and dose guidelines from the International Lymphoma Radiation Oncology Group. Int J Radiat Oncol Biol Phys. 2021;110(4):1064-81. doi: 1016/j.ijrobp.2021.02.011.
- Yoon SE, Song Y, Kim SJ, Yoon DH, Chen TY, Koh Y, et al. Comprehensive analysis of peripheral T-cell and natural killer/T-cell lymphoma in Asian patients: A multinational, multicenter, prospective registry study in Asia. Lancet Reg Health West Pac. 2021;10(100126):100126. doi: 1016/j.lanwpc.2021.100126.
- Vose J, Armitage J, Weisenburger D; International T-Cell Lymphoma Project. International peripheral T-cell and natural killer/T-cell lymphoma study: pathology findings and clinical outcomes. J Clin Oncol. 2008;26(25):4124-30. doi: 10.1200/JCO.2008.16.4558.
- Jain S, Lone MR, Goswami A, Mandal T, Panda AK, Ramteke P, et al. Lymphoma subtypes in India: a tertiary care center review. Clin Exp Med. 2021;21(2):315-21. doi: 1007/s10238-021-00683-2.
- Agrawal M, Champaka G, Amirtham U, Jacob LA, Premalata CS. Extranodal natural-killer/T-cell lymphoma, nasal type: An immunomorphological study from a regional cancer institute in India. J Cancer Res Ther. 2022;18(4):1137-43. doi: 4103/jcrt.JCRT_226_20.
- Khandare P, Saldanha S, Dasappa L, Jacob L, Babu MCS, Lokesh KN, et al. Extranodal NK/T-cell lymphoma-nasal type: Experience from a regional cancer center in India. Muller J Med Sci Res. 2020;11(1):20. doi: 10.4103/mjmsr.mjmsr_39_19.
- Yang Y, Zhu Y, Cao JZ, Zhang YJ, Xu LM, Yuan ZY, et al. Risk-adapted therapy for early-stage extranodal nasal-type NK/T-cell lymphoma: analysis from a multicenter study. 2015;126(12):1424-32; quiz 1517. doi: 10.1182/blood-2015-04-639336
- Qi SN, Yang Y, Song YQ, Wang Y, He X, Hu C, et al. First-line non-anthracycline-based chemotherapy for extranodal nasal-type NK/T-cell lymphoma: a retrospective analysis from the CLCG. Blood Adv. 2020;4(13):3141-53. doi: 10.1182/bloodadvances.2020001852.
- Wang ZY, Li YX, Wang WH, Jin J, Wang H, Song YW, et al. Primary radiotherapy showed favorable outcome in treating extranodal nasal-type NK/T-cell lymphoma in children and adolescents. 2009;114(23):4771-6. doi: 10.1182/blood-2009-07-235853.
- Yahalom J, Illidge T, Specht L, Hoppe RT, Li YX, Tsang R, et al. Modern radiation therapy for extranodal lymphomas: field and dose guidelines from the International Lymphoma Radiation Oncology Group. Int J Radiat Oncol Biol Phys. 2015;92(1):11-31. doi: 10.1016/j.ijrobp.2015.01.009.
- Wang HY, Niu SQ, Yang YY, Li YY, Chen HB, Zhang YJ. Promising clinical outcomes of sequential and "Sandwich" chemotherapy and extended involved-field intensity-modulated radiotherapy in patients with stage IE /IIE extranodal natural killer/T-cell lymphoma. Cancer Med. 2018;7(12):5863-9. doi: 10.1002/cam4.1755.
)