Natural Killer T-Cell Lymphoma (Nasal-Type) Presenting Early as Pain of Odontogenic Origin

Background: NK T-cell lymphoma nasal type is an aggressive and rare form of non-Hodgkin's lymphoma linked closely to Epstein-Barr virus and primarily involves and destroys mid-facial structures with a poor survival rate. The disease is insidious in onset with early non-specific symptoms obscuring an underlying neoplastic process. Case description: A case of NK T-cell lymphoma presenting early with symptoms of chronic sinusitis. Infection of odontogenic origin suspected by primary care physician (PCP) based on the later presentation of associated dental pain. Referral and evaluation by oral care specialists ruled out infection of odontogenic origin but failed to recognize an underlying neoplastic process developing due to the unusual presentation in the absence of nasal congestion, epistaxis and swelling. Clinical relevance: It must be recognized by clinicians that 10% of head and neck malignancies are non-squamous cell carcinomas (SCC) in origin and must be included in the differential diagnosis when symptoms and clinical signs are at variance. Prompt referral to specialists to rule out underlying malignant processes when conventional therapy fails to improve patient-reported symptoms should be made. Delay in diagnosis has a direct impact on treatment morbidity, cost of treatment, quality of life outcomes and on survival outcomes.