Diagnostic Delay: Nasal Polyp to Extra-nodal Natural Killer T-cell Lymphoma - A Case Report

Extra-nodal natural killer/T-cell lymphoma-nasal type (ENKTCL-NT) represents a rare clinical entity that often masquerades as benign lesions during its early stages, resulting in delayed diagnosis and appropriate treatment. The optimal management of this condition hinges on immunohistochemistry, disease stage, and risk stratification based on five critical prognostic factors, which encompass stage, age, performance status, lactate dehydrogenase levels, and primary tumor invasion. Radiation therapy is the cornerstone for achieving locoregional control in localized and advanced disease stages. In this case report, we present the case of a 49-year-old male, who sought medical attention at our center due to uncontrolled epistaxis following an interventional procedure for a suspected nasal polyp. Subsequent examination of histopathology slides and blocks, along with immunohistochemistry, confirmed the diagnosis of ENKTCL-NT, with residual disease evident on positron emission tomography-computed tomography. Following deliberation by the multidisciplinary tumor board, the decision was made to administer radical radiation therapy alone, with a total dose of 5940 cGy (centigray) delivered in 30 fractions employing intensity-modulated radiotherapy techniques, considering the patient’s cardiac comorbidities.