| ObjectiveTo summarize the main clinical manifestations of nasal NKTCL,to further improbe people's umderstanding of nasal NK/T cell lymphoma,to summarize the feasible method to improve the accuracy of clincal diagnosis,analysis of its pathology and immunohistochemical characteristics.MethodA total of 12 patients with nasal NKTCL diagnosed by pathology biopsy from January 2015 to December 2016 were enrolled in this study.Analysis the general data,clinical symptoms,the main traatment before biopsy,the number of biopsy and pothological immunohistochemical characteristics.ResultAll patients were hospitalized,7 males(7/12,58%)and 5 females(5/12,42%)with an average age of 50 years.Eleven patients were given antibiotics(first or second-generation cephalosporins)for 3-5 days before biopsy,and local nasal wash(1 time/day,250 mo of saline)was performed.One patient had no oral antibiotics and nasal rinse.At the same time line of antibiotics and nasal rinse in 11 cases,7cases were biopsy once diagnosed,4 cases for the second biopsy confirmed,1 case of oral antibiotics and bocal nasal rinse biopsy once diagnosed.The main symptoms:11cases of nasal resistance(11/12,92%),11 cases of purulent nasal discharge(11/12,92%),4 cases of epistaxis or tears in the blood(4/12,33%),5 cases with headche or facial pain(5/12,42%),3 cases of nasal septum and palate perforation(3/12,25%),2 cases of frontal or cervical mass(1/12,9%),1 cases of secretory otitis media symptoms(1/12,9%),2 cases of fever>38?(2/12,17%).Signs:6 patients underwent inferior turbinate or middle turbinate(6/12,50%),1 case involving both unilateral inferior turbinate and palate(1/12,9%),2 with nasal septal defect and soft(2/12,16%),2 cases involving nasal septum and nasal sinus muscosa(2/12,16%),1 cases involing nasal septum,nasal and nasopharynx(1/12,9%),1 cases involving turbinate and sinus(1/12,9%).Stage:I stage 6 cases(6/12,50%),II stage 4 cases(4/12,33%),IV stage 1 case(1/12,9%).Immunohistochemistry:Cytoplasmic CD3-positive 12 cases(12/12,100%),Ki-67-positive 12 cases(12/12,100%),EBER-positive 12 cases(12/12,100%),granzyme B positive 11 cases(11/12,92%),TIA-1-positive 11 cases(11/12,92%),B lymphocyte surface markers CD20 positive 2 cases(2/12,17%).Misdiagnosis:5 cases of clinical misdiagnosis in the case:2 cases misdiagnosed as acute sinusitis,1 misdiagnosed as nasal septum deviation,chronic sinusitis and nasal septum correction surgery,1 misdiagnosed as frontal sinus inflammation mass,1 case diasiagnosed as nasal polyp:4 cases of misdiagnosis of imaging:2 cases of misdiagnosed as nasal polyps,1 misdiagnosed as nasopharyngeal carcinoma,1 misdiagnosed as chronic inflammation,1 case of three times were diagnosesd as:Chronic inflammation,squamous cell hyperplasia and small cell carcinoma.ConclusionNasal type NK/T cell lymphoma is a special type of non-Hodgkin's lymphoma,the main symptoms are nasal resistance,purulent nasal discharge and nasal bleeding or tears in the blood,and chronic chinitis,sinusitis clinical symptoms are very similar,as well as smell diminished,local invasive strong can occur nasal septum,soft and hard palate ulcer perforation,clinically easy to diagnose the nasal cavity of other inflammatory lesions and delay the treatment of the disease.Nasal necrotic tissue and more easily associated with infection,biopsy bifore the use of local nasal rinse treatment to improve the success rate of a biopsy have some help.Imaging performance prompted more soft tissue shadow,most of the tios mild enhancement,a small part of the performance can bi significantly enhanced and no significant enhancement,consider the invasion of tumor cells with vascular invasion characteristics.CD56,cytoplasmic CD3,Ki-67,granzyme B and TIA-1 were also expressed in immunohistochemistry.CD20 was expressed in a few cases.EBER was positive in all cases. |
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