case_images: PMC7384497_01
case_images: Preoperative CT scan revealed enhancing lesion (asterisk) with the epicentre occupying and widening the right nasal cavity. Medially it causes nasal septum deviation to the left and thinning of the posterior part of the septum. The lesion extends posteriorly to the nasopharynx.
case_images: MEDJ-35-071-f1.jpg
case_images: PMC7384497_01_MEDJ-35-071-f1.jpg
case_images: F1
case_images: Computed tomography showed that the mass filled the right nasal cavity, caused thinning of the posterior part of the nasal septum, and extended posteriorly into the nasopharynx (Figure 1).
case_images: Intraoperative endoscopic examination of the right nostril. The remnant of the friable reddish mass (long arrow) is seen originated and flushed with the posterior part of right nasal septum (short arrow). The mucosa of the right nasal septum (asterisk) is unhealthy.
case_images: MEDJ-35-071-f2.jpg
case_images: PMC7384497_01_MEDJ-35-071-f2.jpg
case_images: F2
case_images: The patient was taken to the operating theatre and endoscopic examination under general anesthesia (GA) revealed the tumor originated from the posterior part of the right nasal septum (Figure 2).
case_images: Histopathologic examination. The malignant cells are arranged in solid sheets and display large, pleomorphic nuclei with large prominent nucleoli and abundant cytoplasm (A). These cells are immunoreactive toward CD138 (B), MUM1 (C) and CD79a (D), and are negative for CD3 (E) and CD20 (F). EBER-in situ hybridisation is positive (G) and Ki-67 proliferative index is high (H).
case_images: MEDJ-35-071-f3.jpg
case_images: PMC7384497_01_MEDJ-35-071-f3.jpg
case_images: F3
case_images: These cells had large, markedly pleomorphic, vesicular nuclei, some eccentrically located, open chromatin with large prominent nucleoli, and abundant cytoplasm (Figure 3A). An immunohistochemical study showed that the malignant cells were immunoreactive toward CD79a, CD138, and MUM-1, and negative toward CD3 and CD20 (Figure 3 B-F). The Ki-67 proliferative index was 70% (Figure 3H), and the cells were also positive for EBV encoding region in situ hybridization.