So far we have found out James has not been abroad, he is a lifelong non-smoker and has had no previous procedures. He has no past medical history and has no regular medications.
Tests:
Wcc 13, Hb 130, plt 260, neu 12, lymph 1, Eos 0.1
Film: Toxic Granulation of neutrophils.
Na 130, K 4.3, Ur 11, Cr 100, LDH 120 (Normal)
HIV test negative
Nasal exudate culture pending, no growth so far.
James has a CT scan and an assessment by the ENT and Maxillofacial team. They found he had a necrotic ulcer breaching the hard palate from the nasal cavity. His CT scan demonstrates a nasopharangeal mass involving sphenoid and ethmoid sinuses and the anterior nasal cavity. They organise a biopsy, results are awaited
What is the possible Differential Diagnosis?
Any other viral testing you would consider in this case?
Is there a particular immunophenotype you may expect in this case?
TeamHaem 
U did not mention the diffrential WBC
Nash pharyngeal mass might be lymphoma versus carcinoma, sure we need biopsy for histopathology and immnostaining, EBV SCREENING for Ag and antibody could help
The differential diagnosis NHL, natural killer cell lymphoma, lymphoblastic although he is old age
CD34,CD45,TDT, CD 3,CD4,CD8,CD16,CD56,CD20 ,BCL2,BCL6,KI67,Cmyc
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