Central palatal perforation in nasal natural killer cell lymphoma

作者：Yok‐Lam Kwong, Pek‐Lan Khong · 发表于：British Journal of Haematology · 年份：2010 · DOI：10.1111/j.1365-2141.2010.08461.x · 被引用次数：28 · 研究领域：Viral-associated cancers and disorders

Central palatal perforation in nasal natural killer cell lymphomaA 45-year-old man presented with a 2-month history of a painful hard palatal lesion (left upper panel).Physical examination showed an ulcer on his hard palate.A positron emission tomography computerized tomography (PET/CT) scan showed a large nasopharyngeal mass involving the skull base, and sphenoid and ethmoid sinuses, which extended anteriorly to the nasal cavity (arrow, right upper panel).Biopsy of the nasopharyngeal mass showed extranodal natural killer (NK)/T-cell lymphoma, nasal type.His plasma Epstein-Barr virus (EBV) DNA, a surrogate biomarker of lymphoma load, was quantified by real-time polymerase chain reaction to be 4AE7 • 10 5 copies/ml (reference range: undetectable).He was started on the SMILE (prednisolone, methotrexate, ifosphamide, l-asparaginase, etoposide) regimen, and was asymptomatic after the first course of therapy.His plasma EBV DNA had become undetectable, consistent with a complete molecular remission.Contrary to the clinical response, the palatal ulcer continued to enlarge (middle upper panel).By the end of the second course of treatment, a perforation had developed in the hard palate, which communicated with the nasal cavity (left lower panel).A PET/CT performed after three courses of SMILE showed complete anatomical and metabolic remission (right lower panel).However, the palatal perforation still progressed, albeit at a slower rate.After involved-field radiotherapy and completion ...