We report the case of a 42-year-old male, without drug allergies, who had a history of infectious mononucleosis in childhood, left arm fracture 5 years ago, morbid obesity with hepatic steatosis treated by bariatric surgery.
She came to the Otorhinolaryngology consultation due to a left nasal obstruction of a few weeks of evolution, with repeated episodes of purulent rhinorrhea, with sensation of left nasal packing, which is accompanied by a submandibular mass.
At the same time, the patient was sent to the Hematology Department for repeated asymptomatic thrombocytosis.
A bone marrow aspirate/biopsy is performed in patients with suspected essential thrombocythemia, presenting a platelet count of 487,000/ul in the blood count.
The patient underwent a biopsy of the intranasal mass, which is completed with an incisional biopsy of the left submandibular tumor.
Cervical computed tomography showed a mass of balndas parts in the left submaxillary cell, with areas of necrosis or inflammatory adenopatic nature, of 3 centimeters of probable diameter, accompanied by an adjacent regional component.
There was also a second lesion corresponding to dyspareunia with the anterior, a left paralateronasal cyst.
Biopsy of the intranasal lesion consisted of an infiltrate of lymphoid cells with a diffuse growth pattern, without 'stellate sky' images, and with a moderate mitotic rate.
Located cells are of intermediate size, with slightly irregular nuclei and moderate pleomorphism.
Immunophenotype of cells determined by immunohistochemistry was: CD45+/cCD3+/Granzime B +/CD56+, CD20-/CD4-/CD8-B/L1
Biopsy of the submandibular mass revealed an irregular mass due to lymphoid lineage of intermediate or large size, with nuclear irregularities and a tosca, irregular and scarce azurophyllous granulation.
Presenting an immunophenotype identical to the intranasal lesion.
EBER(EBER) determination was positive, there was a polyclonal re-odenation of the gamma chain genes of the T lymphocyte receptor (TCR) and of the genes of the heavy chain of immunoglobulins (Ig).
All this was compatible with the diagnosis of NK extra nasal polyposis.
The patient was immediately referred to the physician's office for evaluation.
The patient had a very good general condition with a performance status of 0, no symptoms B and asymptomatic, except the clinic characteristic of left nasal obstruction.
The extension study was completed with computed tomography and computerized dissemination-2-abdominal, which showed no evidence at a distance, bone marrow biopsy already requested due to suspected essential thrombocythemia, biochemical profile with renal, hepatic, protein microgram, LDH.
The bone marrow examination showed a normocellular parenchyma (3/5), with moderate megakaryocytic hyperplasia with elements in all maturational stages, some of them of hypertrophic aspect, with the remaining series preserved.
There were no data on myelofibrosis or myelofibrosis or granulomas.
There was no lymphomatous disease.
The study of bone marrow does not support (or rule out absolutely) the diagnosis of essential thrombocythaemia.
LDH and beta-2-microglobulin, as well as other biochemical parameters were within the normal range.
Serology for HIV, HBV and HCV were negative.
Hemoglobin and white blood cell counts were normal, with normal leukocyte formula, only a thrombocytosis of 487,000/ul stood out.
With the diagnosis of localized NK lymphoma extra nasal radiation with reactive thrombocytosis type, the patient began treatment with polychemotherapy sequential stage of bone marrow, first line autologous transplantation.
