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