Posters
« Back
138:NK/T-cell Lymphoma, Nasal Type Presents as Hard Palate Ulceration[AAOM2021]
EP36055
Poster Title: 138:NK/T-cell Lymphoma, Nasal Type Presents as Hard Palate Ulceration[AAOM2021]
Submitted on 29 Mar 2021
Author(s): Yao Ke
Affiliations: Department of Oral Medicine, Fourth Military Medical University School of Stomatology
This poster was presented at 2021 American Academy of Oral Medicine Virtual Conference
Poster Views: 332
View poster »


Poster Information
Abstract: Background: NK/T-cell Lymphoma, nasal type (ENKTL, NT) represents an independent subtype of lymphoma mainly affecting people in East Asia and South America with male preference. ENKTL, NT usually shows aggressive behavior prone to develop in the skin and nasal cavity. However, ENKTL, NT cases presented as isolate ulceration of hard plate was not commonly seen.

Case summary: A 58-year-old Chinese male presents with ulceration on the hard palate for 1 month. He developed an intermittent fever two weeks ago, initiating at nightfall and rising to 39°C during the night. The prominent weight loss is another concomitant symptom. He reports no other cutaneous or mucosal involvements and no family history of any oral disease. The lesion is painless but causes great discomfort. He disclosed a history of hypertension and the regulated medication is irbesartan. Intraoral examination shows deep ulceration on the center of the hard palate with prominent necrosis and bone destruction. Positron emission tomography-computed tomography (PET/CT) showed an occupied lesion of the locally incrassate mucous membrane in a lamellar form at the palate, with an anomalously high level of glycometabolism. Histopathological examination showed dense infiltration of lymphocytes with prominent cellular polymorphism and abnormal mitosis in the lamina propria. The neoplastic cells were positive for CD3, CD56, Granzyme B, and Epstein-Barr virus-encoded small RNA (EBER) in situ hybridization. These results suggested a diagnosis of ENKTL, NT. The patient was treated with three cycles of chemotherapy (consisting of asparagine, methotrexate, ifosfamide, etoposide, and dexamethasone) and got a remission from the oral ulcer and fever, and regained his weight after the therapy.

Conclusions: ENKTL, NT clinically features aggressive necrosis that causes midline facial destruction and was used to be named as ‘midline lethal granulomata’. The diagnosis of ENKTL, NT is based on clinical and histological findings. The histopathological presentation is often characterized by tumor cells varying in size with strongly express CD2, CD3, and CD56. Besides, ENKTL, NT is strongly associated with EBV infection and the positive in situ hybridization of EBER is an important diagnostic criterion. Differential diagnosis includes Wegener granulomatosis, non-Hodgkin lymphoma, and various granulomatous infections.
Summary: NK/T-cell Lymphoma, nasal type (ENKTL, NT) represents an independent subtype of lymphoma mainly affecting people in East Asia and South America with male preference. ENKTL, NT usually shows aggressive behavior prone to develop in the skin and nasal cavity. However, ENKTL, NT cases presented as isolate ulceration of hard plate was not commonly seen.

Ask the author questions about this poster: ao.ke@cuanschutz.edu
References: 1)Meng W, Zhou Y, Zhang H, Jiang L, Wang Z, Li X, Zhou H, Chen Q, Zeng X: Nasal-type NK/T-cell lymphoma with palatal ulcer as the earliest clinical manifestation: a case report with literature review. PatholOncol Res 2010, 16(1):133-137.
2)FujiharaS, Mori H, KobaraH, Nishiyama N, Kobayashi M, Masaki T: Esophageal natural killer (NK)/T cell lymphoma of true natural killer cell origin. Endoscopy 2014, 46 Suppl 1 UCTN:E77-78.
3)Jiménez Gallo D, Linares Barrios M: Images in clinical medicine. Destructive ulcerated lesions of the hard palate. N EnglJ Med 2014, 371(17):1629.
4)NagireddyS, Avery RA, KakivayiS, Matin K: Natural killer T-cell lymphoma presenting as adrenal mass and partial adrenal insufficiency followed by CNS involvement. J Clin Oncol 2011, 29(15):e431-433.
Report abuse »
Creative Commons