Extranodal natural-killer/T-cell lymphoma (ENKTL) is a rare type of non-Hodgkin lymphoma. However, it is common in Asia and South America. ENKTL, nasal type (ENKTL-NT), predominantly presents initial unspecific clinical manifestations involving the nasal cavity and its adjacent structures. We present two cases to increase the awareness of the ENKTL-NT cases masquerading inflammatory processes. Although the main clinical feature is a rapidly progressive facial destruction, none of these patients experienced the mentioned complaint. Its various manifestations frequently lead to misdiagnosis and delayed treatment, particularly in those with marked ocular, not nasal symptoms. Our patients were previously diagnosed with inflammatory conditions, namely sinusitis, idiopathic orbital inflammation, dacryocystitis, and orbital cellulitis. The combined approach of chemotherapy and radiotherapy has been proposed as the treatment of choice. Both cases showed young adults treated with combined therapy, yet showing poor outcomes. Clinicians should be aware of its existence and have to consider ENKTL-NT as one of the differential diagnoses in sinonasal or orbital inflammatory cases with unusually rapid progression or unresponsive to treatment.

Objective: To compare the efficacy and safety between chemotherapy and radiotherapy as the main therapy of Extranodal Marginal Zone Lymphoma (EMZL). Method: Literature searching was conducted using PubMed, ScienceDirect, Google Scholar, ProQuest, and SpringerLink. All studies that met the inclusion and exclusion criteria were categorized based on the level of evidence. The data of demographic of the patients, staging of disease, type of treatments, and outcomes of this review including the number of local control rate, disease-free survival rate, overall survival rate, dosage, adverse drug reaction, complication and recurrence and/or relapses were also reported. Result: From ten article, both radiotherapy and chemotherapy as the first-line treatment have high complete remission rate. Local control (complete remission) of chemotherapy group ranged from 56,25%-93,9%, while in radiotherapy group ranged from 70%-100%. Overal survival rate ranged from 92%-100% for chemotherapy group and 90,4%-100% for radiotherapy group. The most complication of the radiotherapy group were cataract formation, while the chemotherapy group showed systemic complications (hematologic or non-hematologic). The most relapse cases were shown in radiotherapy group. Conclusion: Radiotherapy and chemotherapy showed high local control rates and survival outcomes especially in the early stages of extranodal marginal zone lymphoma (EMZL). Radiotherapy had a relatively higher incidence of ophthalmic complications that could interfere with patient’s quality of life. Therefore chemotherapy could be considered especially in younger patients.

Introduction Orbital cellulitis in children is a potentially fatal emergency and develops rapidly, leading to severe visual loss and life-threatening complications. Presentation of case We report a case of a 16-month-old girl who presented to the emergency department unconscious with a four-day history of a swollen right eyelid. CT scan revealed soft tissue swelling at the superior and inferior palpebral region with bilateral maxillary sinusitis. She had a severe sepsis and received intravenous antibiotics. After her general condition improved, she underwent surgical drainage in conjunction with mini-FESS (functional endoscopic sinus surgery)-the culture of purulent material from which Staphylococcus Aureus was isolated. After a few days, she had hospital-acquired pneumonia, and an abscess in her right eyelid reformed. Immunoglobulin test and lymphocyte subset test was normal. The patient underwent re-surgical drainage and had complete resolution of refractory orbital cellulitis. Discussion Severe refractory orbital cellulitis secondary to indolent infection is oftentimes found in immunocompromised patients or in those with underlying ocular diseases; our immunocompetent patient had a seemingly mild case of sinusitis which quickly progressed to severe orbital cellulitis. Oftentimes, broad-spectrum antibiotics are sufficient to treat orbital cellulitis, however, the same cannot be said for our patient, abscess reformed despite appropriate definitive antibiotic therapy in accordance with the culture results. Conclusion While the main treatment of orbital cellulitis is administration of antibiotics, in certain conditions as found in our patient, patients may not respond well to conservative treatment. Thus, close monitoring is essential, and any sign of progression warrants prompt surgical drainage.