A 72-year-old woman, who consulted in September 2000, for presenting an ulcerated lesion in the palatine mucosa of the right maxillary region, of one week of evolution, associated with facial discomfort.
His history included recurrent right maxillary sinusitis since 1995, which had required endoscopic curettage three times, and biopsies were negative for malignancy in all cases.
Examination revealed an ulceronecrotizing palatal lesion of approximately 2 x 2 cm in diameter, with bony imprints, necrotic background and accompanied by a superficial erosion.
The rest of the oral, facial and cervical examination was normal.
There was no involvement of general status or fever.
In the radiological examination performed at that time orthopantomography and computed tomography (CT), only an opacification of the right maxillary sinus without bone destruction was observed, which given the patient's history was not striking.
In the analyses performed, a significant increase in erythrocyte sedimentation rate ESR of 62 mm in the first hour and an increase in C-reactive protein (CRP) were observed.
The biopsy did not provide specific findings that would allow classifying the lesion or ruling out malignancy.
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With the results available at that time, a differential diagnosis was proposed with all ulceroproliferative lesions of the settlement tip.
Despite this, and given that the clinical picture of pain was increasing, empirical treatment with corticosteroids was established, achieving a slight improvement, which was not maintained over time.
At two months there was a worsening of both pain and ulceration, which extended to the entire right hemimaxillary, including the alveolar process and the ipsilateral vestibule fundus.
The CT performed at that time revealed the existence of jugular cervical lymphadenopathy smaller than 1 cm, occupation of the right maxillary sinus, now with destruction of the anterior wall and involvement of adjacent soft tissues.
A new biopsy was then performed at the bottom of the right vestibule, resulting from extralymphatic T/NK non-Hodgkin lymphoma lymphoproliferative syndrome.
The presence of EBV was not confirmed by classical techniques.
Three years later, after reviewing the pathological samples available in the case, their presence was confirmed by using in situ hybridization techniques that had not been used at the time of diagnosis.
In the systemic screening performed, no other foci of neoplasia were observed in the organism.
A multidisciplinary treatment was established with induction chemotherapy (PTC) and radiotherapy (RTP).
QTP was initiated, based on cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP), but was suspended in the second cycle when there was no response, with increased tumor mass.
Radical radiotherapy was then performed with the technique of lateral opposite fields to reach doses of 45-50 Gy with Co60.
The response to treatment was the death of the patient in January 2001 due to a sepsis caused by Pseudomonas secondary to panniculitis caused by the treatment.
