Chou Yu-Pu, Hsieh Li-Chun, Chen Tung-Ying, Wang Ying-Piao
Department of Otolaryngology Head and Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan.
School of Medicine, Mackay Medical College, New Taipei City, Taiwan.
Ear Nose Throat J. 2025 Mar;104(1_suppl):194S-197S. doi: 10.1177/01455613221131301. Epub 2022 Oct 1.
Nasal extranodal NK/T-cell lymphoma (NNKTL) is a lethal disease due to poor prognosis with rapid progress. A 56-year-old man complained of left nasal obstruction and blood-stained nasal drip for two months. Incisional biopsies were performed at the outpatient department three times, and the diagnosis of SCC was made. The patient underwent wide excision of the entire lesion via endoscopic sinus surgery with navigation. Final pathologic report revealed NNKTL. Pathological examination of the tumor revealed overlying epithelium presenting as pseudoepitheliomatous hyperplasia (PEH), which mimicked SCC invasion, with infiltration of atypical lymphocytes in the deeper sections. Immunohistochemistry supported the diagnosis of NNKTL. Chemoradiotherapy was administered, and a complete response was achieved at the two-year follow-up. The correct diagnosis of NNKTL is essential for prompt treatment and prevention of superfluous surgery. Although the link between PEH and NNKTL may lead to a misdiagnosis of SCC, multiple large and deep biopsies can prevent this dilemma. A biopsy showing ulceration or necrosis can indicate PEH and imply potential malignancy. Repeated biopsies and complete immunohistochemical studies are important for diagnosing NNKTL.
鼻结外NK/T细胞淋巴瘤（NNKTL）是一种预后较差、进展迅速的致命性疾病。一名56岁男性主诉左侧鼻塞和带血鼻涕两个月。在门诊进行了三次切开活检，诊断为鳞状细胞癌（SCC）。患者通过导航下的鼻内镜鼻窦手术对整个病变进行了广泛切除。最终病理报告显示为NNKTL。肿瘤的病理检查显示覆盖上皮呈现假上皮瘤样增生（PEH），类似SCC浸润，在更深层可见非典型淋巴细胞浸润。免疫组化支持NNKTL的诊断。给予了放化疗，在两年随访时达到了完全缓解。NNKTL的正确诊断对于及时治疗和避免不必要的手术至关重要。虽然PEH与NNKTL之间的关联可能导致SCC的误诊，但多次大而深的活检可以避免这种困境。显示溃疡或坏死的活检可提示PEH并暗示潜在恶性。重复活检和完整的免疫组化研究对于诊断NNKTL很重要。
