(BMJ)—A man in his 30s presented w/ a 2-mo hx of drainage and a painless obstructive mass in his R anterior nares. He had no pain or bleeding, and tx for presumptive rhinitis was unsuccessful. Exam: mass w/ yellow exudates, w/ L-shifted columella. What’s the dx?
Nasal lymphoma
Tertiary syphilis
Fungal ball
Squamous cell carcinoma
Granulomatous invasive fungal rhinosinusitis
You are correct. Biopsy showed abundant lymphoid cells infiltrating the subepithelial region of the mucosa, consistent w/ extranodal natural killer/T-cell lymphoma, nasal type. A PET-CT scan showed uptake in the nasal mass. Extranodal natural killer/T-cell lymphoma, nasal type, is a rare subtype of non-Hodgkin lymphoma. It has a poor prognosis and, in the early stages, is often assumed to be sinusitis or nasal polyps. Consider malignancy when nasal obstruction isn’t alleviated w/ medical tx.

BMJ 2020;370:m2251