Anti-EBV Nuclear Antigen chimeric monoclonal antibody, clone H7G5E4

T-cell lymphomas are infrequently encountered in the head and neck area, with the most common subtype being Extranodal NK/T cell lymphoma, nasal type (ENKTL-NT). ENKTL-NT shows a predilection for midline facial structures presenting with ulcerative destructive lesions, whereas palatal involvement is one of the most prominent signs from the oral cavity. Herein, we describe a case of a 76-year-old Greek man with nasal obstruction and an extensive painful necrotic ulcer with ragged borders on the left distal portion of the soft palate and palatine tonsil of 4-months duration. After an initial non-diagnostic biopsy from the nasopharynx, a second incisional biopsy from the palatal lesions was performed. Histopathology was suggestive of an angiocentric lymphoproliferative neoplasm and immunohistochemical examination and in situ hybridization for EBV RNA led to a final diagnosis of ENKTL-NT. The patient was placed under combined chemotherapy and radiotherapy and no recurrence has been noted. Additionally, a retrospective review of the cases in the English literature with an established diagnosis of ENTKL-NT between 2000 and 2019, based on the latest WHO classification of Head and Neck tumors, is performed.

Introduction Nasopharyngeal carcinoma (NPC) is an Epstein-Barr virus (EBV)-associated tumor occurring in southeastern Asia. Due to insidious onset, it is difficult to diagnose NPC from clinical symptoms. Thus, there is an urgent need for non-invasive, high-performance biomarkers to aid the clinical diagnosis of NPC. Heat shock protein 90 alpha (HSP90 alpha) is an important member of the heat shock protein family that significantly increases under stress conditions such as oxidation and tumors. This is the first investigation of the role of Hsp90 alpha in the diagnosis and progress of NPC. Methods Plasma Hsp90 alpha was detected by ELISA in 196 newly diagnosed NPC patients, 76 corresponding post-treatment NPC patients, 230 VCA-IgA-positive normal subjects and 106 healthy controls. Results (1) The level of Hsp90 alpha in plasma of 196 NPC patients was (212.16 +/- 144.32) ng/ml, which was significantly higher than that in VCA-IgA-positive normal subjects (68.12 +/- 64.94 ng/ml, P < 0.001) and healthy controls (35.87 +/- 17.47 ng/ml, P < 0.001); (2) the levels of Hsp90 alpha in patients with NPC in the early stage (I + II), stage III and stage IV were significantly different (159.69 +/- 117.12 pg/ml vs. 195.24 +/- 126.38 pg/ml vs. 250.85 +/- 164.66 pg/ml, P = 0.018 and P = 0.029, respectively). The level of Hsp90 alpha in plasma in patients with metastasis of NPC and those without metastasis was significantly different (P < 0.001); (3) Hsp90 alpha is closely related to EBV DNA levels, but not to the VCA-IgA titer and EA-IgA titer; (4) the levels of Hsp90 alpha in plasma of patients with NPC before and after treatment were significantly different (212.16 +/- 144.32 pg/ml vs. 62.36 +/- 34.04 pg/ml, P < 0.001); (5) the ROC curves demonstrated that the sensitivity of plasma Hsp90 alpha in distinguishing NPC patients from healthy controls was 74.50% and the specificity was 99.10% (AUC = 0.931, 95% CI 0.903-0.958). Conclusion The study found that the plasma HSP90 alpha level is closely related to the clinical stage, metastasis and therapeutic effect of NPC. HSP90 alpha may serve as a new biomarker for diagnosis and treatment of NPC.