Abstract
Radiologic feature of primary nasopharyngeal lymphoma is a predominantly homogenous, nonnecrotic large tumor with no or minimal deep tissue invasion. To the best knowledge, nasopharyngeal lymphoma has not been presented with hemorrhagic necrosis. Thus, we report 2 cases of nasopharyngeal lymphoma with hemorrhagic necrosis mimicking an abscess. The patients had bleeding diathesis such as aplastic anemia or idiopathic portal hypertension.
1
Introduction
Non-Hodgkin lymphoma (NHL) accounts for 5% of malignancies of the head and neck . Most NHLs of the head and neck arise in the extranodal lymphatic system of Waldeyer ring . The diagnosis of NHL is suggested when imaging reveals a tumor involving multiple sites in Waldeyer ring. However, primary lymphoma of the nasopharynx is much less common and, clinically, is more likely to be diagnosed as an nasopharyngeal carcinoma . Generally, imaging reveals that nasopharyngeal NHL is a predominantly homogenous, nonnecrotic large tumor with no or minimal deep tissue invasion . To the authors’ best knowledge, nasopharyngeal NHL has not been presented as hemorrhagic necrosis. In this study, we report 2 cases of nasopharyngeal NHL with hemorrhagic necrosis mimicking an abscess in the patients with coagulopathy.
2
Case reports
2.1
Case 1
A 23-year-old man was referred to otorhinolaryngology department because of high fever and sore throat from internal department. Four years ago, he was diagnosed as severe aplastic anemia. Complete blood count demonstrated severe thrombocytopenia (24 000 μ /L). Nasal endoscopy revealed obstruction of both posterior choanae by a huge nasopharyngeal mass accompanied with necrotic material. No cervical lymphadenopathies were felt. Neck computed tomographic (CT) imaging revealed a diffuse soft tissue mass with mild peripheral enhancement involving both nasopharyngeal walls ( Fig. 1 A and B). On magnetic resonance (MR) imaging, the mass showed 3 layers. On T2-weighted imaging (T2WI), the mass was inhomogenously hypointense center, relatively homogenously isointense peripheral, and intervening more hypointense layer ( Fig. 2 A ). On T1-weighted imaging (T1WI), the mass demonstrated heterogenouse center, isointense periphery, and intervening hypointense layer ( Fig. 2 B). Postcontrast image showed strong contrast enhancement only at the peripheral layer ( Fig. 2 C). He underwent a transnasal endoscopic biopsy under general anesthesia. Histopathologic examination revealed NHL of diffuse large B-cell type.
2.2
Case 2
An 11-year-old man was referred to otorhinolaryngology department because of high fever and sore throat for 10 days from pediatrics department. One year ago, he underwent splenic artery embolization due to splenomegaly after idiopathic portal hypertension. Laboratory test revealed severe liver dysfunction (aspartate aminotransferase level, 218 IU/L; alanine aminotransferase level, 154 IU/L; lactate dehydrogenase level, 1122 IU/L) and coagulopathy including prothrombin time and activated partial thromboplastin time prolongation. Although he received antibiotics treatment, high fever and weight loss were continued. Nasal endoscopy revealed obstruction of both posterior choanae by a large nasopharyngeal mass accompanied with necrotic material. Neck CT imaging demonstrated slightly hypodense soft tissue mass at the left nasopharynx with mild peripheral contrast enhancement ( Fig. 1 C and D). On MR images, the mass showed inhomogenous hypointensity on T2WI ( Fig. 3 A ), isointensity on T1WI ( Fig. 3 B), and intense peripheral contrast enhancement ( Fig. 3 C). He underwent a transnasal endoscopic biopsy and histopathologic examination revealed natural killer/T-cell lymphoma.
