Facial oedema and destructive lesion of the hard palate

This is a necrotic ulcerated lesion with irregular margins on the hard palate (fig 1) of a Equadorian man in his 50s.bmj;379/nov02_1/e071929/F1F1f1Fig 1He presented with facial swelling, weight loss, and mouth pain. Computed tomography and nasal endoscopy only showed signs of rhinosinusitis with oedematous changes of the facial region. Similarly, findings from initial microbial cultures and biopsies of specimens from the ulcer, turbinates, and paranasal sinuses were negative or inconclusive. Extranodal natural killer cell T cell lymphoma, nasal type, was finally diagnosed from histopathological examination of further biopsy specimens from the turbinates. This condition is a subtype of Epstein Barr virus related non-Hodgkin’s lymphoma, previously known as lethal midline granuloma, and is rare outside of Asia and South America. It usually appears with extranodal presentation within the upper aerodigestive tract, commonly involving the nasal cavity, nasopharynx, and paranasal sinuses.1 In patients presenting with facial swelling, an oral examination should always…
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