PMC5977006_01
Fiberoptic endoscopic examination of the left nasal cavity shows diffusely whitish exudates coating on the mucosal surface.
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Fiberoptic endoscopy of the left nasal cavity showed mucosal erosions and whitish exudates coating the mucosal surface (Figure 1).
Contrast-enhanced CT of the head and neck reveals iso-enhancing masses in the left nasal cavity, nasopharynx, and paranasal sinuses, accompanied by bilateral neck lymphadenopathy.
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Multiple enlarged and enhancing lymph nodes were observed at bilateral levels IB, II, III, IV, and V (Figure 2).
FNAC of the left neck lymph node. (a) Lymphoid cells varying in size and shape (Liu's stain, 400x). (b, c) Intermediate to large cells with irregular nuclei, central nucleoli, tongue-like cytoplasmic protrusions, and fine or coarse azurophilic granules (Liu's stain, 1000x). (d) Cytoplasmic protrusions are visible in LBC (Pap stain, 1000x).
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Cytoplasmic projections with tongue-like protrusions and fine or coarse cytoplasmic azurophilic granules were also present (Figure 3). Variously shaped cytoplasmic processes were also visible in Papanicolaou stained slides (Figure 3).
Cell block preparation from the residual FNAC specimen. (a) Neoplastic lymphoid cells with nuclear irregularity (H&E stain, 400x). Immunocytochemical analysis shows lymphoma cells positive for CD56 (b) and granzyme B (c). Nuclei are positive for EBER by in situ hybridization (d) (200x).
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The immunophenotype of atypical cells was thus demonstrated by cell block sections (Figure 4).
Morphological features of nasal tumor. (a) Low-power view shows diffuse cellular infiltrates with necrosis and mucosal ulcer (H&E, 100x). (b) High-power view shows a mixture of small-, medium-, and large-sized cells with angiocentric growth pattern (H&E, 200x). Immunohistochemical study: (c) the tumor cells are positive for granzyme B (C). Nuclei are positive for EBER by in situ hybridization (d) (400x).
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The neoplastic cells exhibited an angiocentric growth pattern, as well as angiodestruction with mural fibrinoid necrosis and hemorrhage (Figure 5). On immunohistochemical staining, the atypical lymphoid cells stained positive for CD56, granzyme B, and CD3 and negative for CD20 and cytokeratin (AE1/AE3) (Figure 5). The neoplastic cells tested positive on in situ hybridization for EBER (Figure 5).