PMC6330188_01
Tongue depressed with wooden spatula revealing soft tissue mass extending from the nasopharynx and involving uvula.
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Oral examination revealed a single soft mass extending from nasopharynx involving the uvula at the soft palate [Figure 1].
Nasopharyngeal mass completely obstructing the (a) right posterior choana and (b) left posterior choana.
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Nasoendoscopy revealed a smooth-surfaced, highly vascular mass occupying the whole nasopharynx, completely obstructing right posterior nasal choana [Figure 2a], and 90% of the left posterior nasal choana [Figure 2b].
(a) Hematoxylin and eosin staining revealed atypical lymphoid cells of medium size with a round to oval shape with vesicular nuclei and irregular nuclear membrane, magnification = 400 x. (b) The atypical lymphoid cells were positive for CD20 (brown) immunohistochemical stain, magnification = 40 x. A similar positivity pattern was seen for CD79a, CD5, and cyclin D1 (images not shown). (c) The atypical lymphocytes were negative for CD3 immunohistochemical stain, magnification = 40 x. A similar negativity pattern for CD10 and CD23 was seen (images not shown). (d) Ki-67 staining (brown) revealed a proliferative index of 20-30%, magnification = 40 x.
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Proliferative index (Ki-67) was about 20-30% without overt blastic change seen [Figure 3].