NK/T cell Lymphoma Case

presentation
Anthony Muchiri
Oncology Clinical Officer
ICI Care and Research Clinic
Monday, 25th October 2021
 Demographics

• Name: D.B.M
• Age: 53 years
• Gender: Male
• Residence: Bungoma, Kenya
• Date of first encounter: 08/10/2021
Presenting Complaints

• Left nasal blockage- 5 months

• Neck swellings- 5 months
History of Presenting Illness
• 53 year old male, non smoker, unknown HIV status
• Presented with left nasal blockage and neck swellings since May 2021.
• On and off epistaxis.
• B symptoms- HOB, weight loss 14 kgs.
• CT base of skull/ PNS (21/07/2021)
• Soft tissue attenuating mass involving left nasal cavity, left maxillary and ethmoid
sinus, bilateral frontal and sphenoid sinuses with no osseous involvement.
• Right maxillary sinus mucosal thickening.
• August 2021- Functional Endoscopic Sinus Surgery
• Excision of the mass
• Biopsy and histology (24/08/2021):
• Morphologic features suggestive of a lymphoproliferative disorder favor non-Hodgkin
lymphoma.
• IHC recommended.
• Immunohistochemistry (06/10/2021)
• CD 30 focal positive, CD 3 patchy positive
• CD 10, CD 20 negative
• AE1/AE3 negative, Synaptophysin, S100, HMB45 negative
• Ki-67: 70%.
• Morphologic and immunophenotypic features of Non-Hodgkin’s lymphoma
favor NK/T cell lymphoma.
CT base of skull/ PNS
Histology IHC
Current issues;
• Hotness of body
• Difficulty in breathing due to left nasal occlusion
• Oral thrush
Physical Exam on day of encounter
• FGC, ECOG 1
• BP 112/60mmHg, PR 130b/min, RR 20b/min, T 39.0⁰c , SPO2 98% RA, WT 76
Kgs
• Left sided facial swelling (maxillary, lower orbit, nasal and mandibular areas)
• Mass occluding the left nasal space
• Palpable LNs in the neck bilaterally (cervical, submental, submandibular),
Left supraclavicular, occipital- septic
R/S- Clear chest with adequate air entry.
P/A- hepatomegaly
Plan:
• Admit patient- CBC, UECs, LFTs, LDH, Uric acid
• CT chest, abdomen and pelvis
• IV antibiotics, analgesics, antifungals
• Allopurinol
• Patient to start on chemotherapy once stable
Lab works (15/10/2021)
CBC 12/10/2021 20/10/2021 UECs/LFTs Result Range
WBC 27.88 40.59 Urea 3.8 1.7-8.3
ANC 21.63 30.82 Creatinine 74.48 40-97
LYMPH 2.86 4.43 Sodium 129.3 135-145
Hb 4.7 11.2 Potassium 3.76 3.5-5.5
PLT 13 22 Chloride 95.2 98-108
GGT 37.05 6-61
ALP 144 40-302
Serum uric acid 363.36 200-420 ALT 13 0-42
LDH AST 15.18 0-37
Total protein 66.85 66-87
T. Bilirubin 10.02 2-21
CT Chest CT
Abdomen&Pelvis
04.07.21 11.10.21
In the ward:
• Transfused 6 pints of PRBCs
• IV ceftriaxone, IV perfalgan, nystatin drops
• Occipital abscess on U/S. Patient declined I&D
• Abdominal-pelvic CT scan
• Few cysts in the liver
• No hepatosplenomegaly or abdominal adenopathy
Assessment
• 53 YOM, presented with left nasal blockage and neck swellings for 5
months.
• FESS - excision biopsy done.
• Histology: Morphologic features suggestive of a lymphoproliferative
disorder favor non-Hodgkin lymphoma on histology.
• IHC: Morphologic and immunophenotypic features of Non-Hodgkin’s
lymphoma favor NK/T cell lymphoma- nasal type.
• Staging CT scans: Stage IIB.
• Currently presenting with bicytopenia and sepsis due to occipital abscess