[Relapse in the nasal cavity of a patient with extranodal NK/T-cell lymphoma initially presenting as plantar subcutaneous tumor].

A 36-year-old woman complained of a mass on the sole of her foot in February 200X. She was diagnosed with extranodal NK/T-cell lymphoma, nasal type (ENKL) by skin biopsy. Because the lesion was localized on the subcutaneous tissue of the sole, she was treated with RT/2/3DeVIC, resulting in a complete response (CR). In March of the following year, PET/CT showed significant uptake and mucosal thickening in the right nasal cavity, and a mucosal biopsy confirmed ENKL infiltration. Because the lesion was localized in the nasal cavity, she was re-treated with RT/2/3DeVIC, with a focus on local control, and she achieved a second CR. She subsequently received allogeneic hematopoietic stem cell transplantation in the hope of preventing systemic relapse. She has remained in CR for four years since the transplantation. Our case suggests that allogeneic hematopoietic stem cell transplantation to be a potentially promising approach to curative treatment for recurrent ENKL in younger patients. As nasal lesions may subsequently appear during the course of primary non-nasal ENKL, ongoing meticulous evaluation for nasal lesions is important.

[Markedly increased red cell fragmentations counted as platelets in a patient with thrombotic microangiopathy].

A patient with acute lymphocytic leukemia (ALL) experienced severe thrombotic microangiopathy (TMA) after allo-bone marrow transplantation (BMT). She had high risk for TMA; due to total body irradiation (TBI), intensive chemotherapy, treatment with Ciclosporin and association with veno-occlusive disease (VOD). Markedly increased fragmentations of red blood cells were observed in this case, and were incorrectly counted as platelets by a fully automated blood cells counter. Careful evaluation of the platelet count is necessary in patients with red cell fragmentations.