A Destructive Midline Facial Lesion: An Elusive Diagnosis

Extranodal NK/T-cell lymphoma is a highly aggressive EBV-driven lymphoma that can masquerade as benign inflammatory or infective midline lesions, often leading to delayed diagnosis. Extensive necrosis and angio-destructive growth may render biopsies inconclusive; repeat deep biopsy with immunohistochemistry and EBER testing is often required to establish diagnosis and avoid misinterpretation. Early recognition is critical, outcomes depend on prompt initiation of asparaginase-based regimens with radiotherapy.