PMC4748798_01
MRI of the face with contrast medium revealed the presence of an 8.3 x 4.8-cm heterogeneous mass lesion involving both nasal airways with obstruction and destruction of the nasal septum. There is extension into the underlying hard palate and into the left ethmoid, sphenoid, left maxillary sinuses, soft palate and uvula.
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F1
MRI of the face with contrast medium revealed the presence of an 8.3 x 4.8-cm heterogeneous mass lesion involving both nasal airways with obstruction and destruction of the nasal septum (fig. 1).
Sections demonstrate a dense, diffuse, pandermal proliferation of atypical lymphoid cells with eosinophilic cytoplasm, hyperchromatic nuclei, irregular nuclear membranes and inconspicuous nucleoli. Extensive apoptosis, prominent angiocentricity, focal epidermotropism and dermal necrosis are noted. The tumor cells were strongly immunoreactive for TIA-1, granzyme, CD8, CD2, CD56 and cytoplasmic CD3. A few cells were immunoreactive for CD5 and CD4. EBER in situ hybridization was positive in the majority of the neoplastic cells. The cells were negative for CD57. The findings are consistent with ENKL of the nasal type.
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F2
Extensive apoptosis, prominent angiocentricity, focal epidermotropism and dermal necrosis were noted (fig. 2).
A 3 x 3-cm, erythematous, violaceous, well-circumscribed nodular lesion on the left thigh.
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F3
Later on, she was found to have multiple erythematous, violaceous, well-circumscribed, nodular lesions over the back and bilateral thighs (fig. 3).