<h3>Introduction</h3> Extranodal NK/T-cell lymphoma, nasal type (ENKTL) is a rare, but highly aggressive entity. It occurs most commonly in Asia and native populations of Mexico and Central and South America. This case report details the clinical course of a patient who initially presented for work-up of pancytopenia, and was ultimately found to have a diagnosis of Extranodal NK/T-cell Lymphoma. The patient underwent biopsies of multiple sites including the bone marrow, lymph node, tonsil, and buccal gingiva, with the latter biopsy giving the most definitive, unequivocal result. <h3>Clinical Presentation</h3> A 38 year old Asian male presented to the emergency department for pancytopenia and fevers after he was previously found to be anemic with low hemoglobin levels. His physical examination was notable for right tonsillar enlargement with exudate, a white mass on the right palate, sinusitis, and lymphadenopathy. A bone marrow biopsy was performed and diagnosed as EBV lymphoproliferative disorder with T/cytotoxic cell proliferation, and the differential diagnosis included a T/NK cell neoplasm. Subsequent biopsies of a cervical lymph node and the right tonsil were performed with the lymph node being diagnosed as idiopathic multicentric Castleman's disease; EBV-positive, HHV8-negative. As treatment, the patient was started on siltuximab. The necrotic mass on the palate continued to worsen, extending to the maxillary anterior buccal gingiva. Fortunately, after some time, the patient was referred to oral surgery and a biopsy of the right buccal gingiva was performed, revealing the final diagnosis of ENKTL. The patient was diagnosed with stage IV disease, received treatment with the SMILE regimen, underwent a stem cell transplant, and was overall stable 17 months post-transplant. <h3>Conclusion</h3> This case highlights the importance of thorough oral examinations and timely sampling of any lesions present, as these practices can aid in arriving at an accurate diagnosis.