PMC5892269_01
Scope image and computed tomography (CT) findings. (a) Scope image of the left nasal cavity. White granulation tissue is observed (arrow). *: inferior turbinate and  : nasal septum. (b) Axial CT with contrast demonstrating soft tissue lesions or effusions in the ethmoid and sphenoid sinuses. (c) Axial CT with contrast demonstrating mucosal and tissue swelling in the pharynx.
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Nasal fiberscopy findings showed that the nasal cavity and nasopharynx were filled with a viscous exudate and granulation tissue (Figure 1(a)). Computed tomography (CT) scans demonstrated space-occupying lesions in the bilateral ethmoid and sphenoid sinuses and a soft tissue lesion from the nasopharynx to the oropharynx (Figures 1(b) and 1(c)).
Morphological and immunohistochemical characteristics of the lymphoma (x200). (a) In situ hybridization with EBER showing strong Epstein-Barr virus expression by a large atypical lymphocyte. (b) Immunohistochemical staining with CD3 showing strong positive staining. (c) Immunohistochemical staining with CD56 showing negative staining.
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Reanalysis of pathology specimens yielded positive results for Epstein-Barr virus-encoded early small RNA (EBER), cluster of differentiation 3 (CD3), CD4, and granzyme A, and negative results for CD56 (Figures 2(a)-2(c)), leading to an eventual diagnosis of nasal-type extranodal NK/T-cell lymphoma (ENKL).