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case_images: The development process of facial lesions within 4 months. (A) Initially, there is an ulcer on the right wing of the nose, congestion, and edema of the surrounding skin. (B) The ulcer gradually improves after anti-infection treatment. (C) The lesion quickly spreads to the right inner canthus, nasal root, right cheek, and nasolabial groove. (D) The image depicts a man with an atypical presentation characterized by midfacial edema, necrotizing and destructive mass, bilateral periorbital involvement, and contracture atresia of the right nostril.
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case_images: Over the course of six months, the lesion gradually spread from the right ala nasi to encompass the entire face (Figure 1). At the beginning of the disease, the main manifestation was an ulcer on the right wing of the nose with little secretion on the surface, a local brown crust, and congestion and edema of the surrounding skin (Figure 1A). Histopathological analysis of the two biopsies revealed that the hyperplastic inflammatory granulation tissue is accompanied by pseudotumor-like hyperplasia of some epithelia (Figure 1B). After external application with traditional Chinese medicine, the lesion quickly spread to the right inner canthus, nasal root, right cheek, and nasolabial groove (Figure 1C). The wound was covered with a significant amount of yellow-green pus mixed with cotton wool from gauze (Figure 1D).
case_images: The axial CT (A) and MRI (B) scan reveals a substantial area of tissue loss in the midfacial region, involving the nasal bone and resulting in markedly asymmetrical facial contours.
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case_images: CT (Figure 2A) and MRI (Figure 2B) of the head and paranasal sinuses showed swelling and thickening of the soft tissues near the forehead and bilateral eyelids, absence of local skin and subcutaneous soft tissues in the maxillofacial region, and local defects of the nasal bone.
case_images: Microscopic hematoxylin and eosin, and in situ hybridization features. (A) The image shows a lymphoid infiltrate comprising moderate to large cells with an angiocentric and angiodestructive growth pattern (H-E,x200). (B) The positivity of Epstein Barr virus by in situ hybridization is essential for confirming the diagnosis (ISH-EBV,x400).
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case_images: Tumor cell invasion and destruction of blood vessel walls were also evident (Figure 3A). Lastly, the diagnosis of nasal type extranodal NK/T-cell lymphoma is aided by the positivity of Epstein-Barr virus by in situ hybridization (EBER+) (Figure 3B).