Severe Nasal Swelling | Otolaryngology | JN Learning | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

Severe Nasal Swelling

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

A 32-year-old Hispanic man without significant medical history presented with nasal pain and swelling, progressive for 6 weeks. He had been hospitalized for this problem at an outside hospital and treated with antibiotics, without improvement. The swelling worsened and extended to his upper lip. He developed difficulty swallowing, headache, and nasal drainage. On presentation, he was afebrile without leukocytosis. Physical examination demonstrated diffuse swelling and tenderness of the nose with honey-colored crusting that extended to above his upper lip.

Please finish quiz first before checking answer.

You answered correctly!

Read the answer below and download your certificate.

You answered incorrectly.

Read the discussion below and retake the quiz.

A. Extranodal T-cell lymphoma

With a presumed diagnosis of nasal vestibular abscess refractory to conservative management, the patient underwent incision and drainage, without purulence noted. He was taken to surgery, where nasal cavities were filled with necrotic debris, and a perforation was noted along the cartilaginous segment of the nasal septum. Biopsy demonstrated atypical angiocentric and angiodestructive natural killer and T (NK/T)–cell proliferation, positive for cytoplasmic CD3, CD2, CD7, CD30, CD56, granzyme B, and TIA1 and negative for surface CD3, CD4, CD5, CD8, and CD57. In situ hybridization for Epstein-Barr virus–encoded RNA was diffusely positive, supporting the diagnosis of extranodal NK/T-cell lymphoma, nasal type. Results of a bone marrow biopsy were normal. Staging fludeoxyglucose F 18–labeled positron emission tomography and CT demonstrated multiple bilateral fludeoxyglucose F 18–avid cervical lymph nodes. The patient began treatment with dexamethasone, etoposide, ifosfamide, and carboplatin (DeVIC regimen) with concurrent radiotherapy.

Survey Complete!

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

Article Information

Corresponding Author: Keivan Shifteh, MD, Department of Radiology, Division of Neuroradiology, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (kshifteh@montefiore.org).

Published Online: November 8, 2018. doi:10.1001/jamaoto.2018.2707

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References
1.
Jaffe  ES, Chan  JK, Su  IJ,  et al.  Report of the Workshop on Nasal and Related Extranodal Angiocentric T/Natural Killer Cell Lymphomas: definitions, differential diagnosis, and epidemiology.  Am J Surg Pathol. 1996;20(1):103-111. doi:10.1097/00000478-199601000-00012PubMedGoogle ScholarCrossref
2.
Kim  J, Kim  EY, Lee  SK,  et al.  Extranodal nasal-type NK/T-cell lymphoma: computed tomography findings of head and neck involvement.  Acta Radiol. 2010;51(2):164-169. doi:10.3109/02841850903476572PubMedGoogle ScholarCrossref
3.
Aiken  AH, Glastonbury  C.  Imaging Hodgkin and non–Hodgkin lymphoma in the head and neck.  Radiol Clin North Am. 2008;46(2):363-378, ix-x. doi:10.1016/j.rcl.2008.03.001PubMedGoogle ScholarCrossref
4.
Tse  E, Kwong  YL.  The diagnosis and management of NK/T-cell lymphomas.  J Hematol Oncol. 2017;10(1):85. doi:10.1186/s13045-017-0452-9PubMedGoogle ScholarCrossref
5.
Pakalniskis  MG, Berg  AD, Policeni  BA,  et al.  The many faces of granulomatosis with polyangiitis: a review of the head and neck imaging manifestations.  AJR Am J Roentgenol. 2015;205(6):W619-W629. doi:10.2214/AJR.14.13864PubMedGoogle ScholarCrossref
6.
Eggesbø  HB.  Imaging of sinonasal tumours.  Cancer Imaging. 2012;12:136-152. doi:10.1102/1470-7330.2012.0015PubMedGoogle ScholarCrossref
7.
Koeller  KK.  Radiologic features of sinonasal tumors.  Head Neck Pathol. 2016;10(1):1-12. doi:10.1007/s12105-016-0686-9PubMedGoogle ScholarCrossref
8.
Choi  MG.  Necrotizing fasciitis of the head and neck: a case report.  J Korean Assoc Oral Maxillofac Surg. 2015;41(2):90-96. doi:10.5125/jkaoms.2015.41.2.90PubMedGoogle ScholarCrossref
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Close
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close