Invasive nasopharyngeal carcinoma - growing up into the clivus
A 45-year-old woman with severe headache.
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CT scan shows heterogeneous intensely enhancing lobulated contour mass arising in nasopharynx, with destruction of the clivus. Mass invades left sphenoid sinus through dorsal wall defect and extends toward intersinus septum "lifting" sellar floor with no evidence of invasion to adenohypophysis. Tumor extends into foramen lacerum, medial petrous carotid canal, vertical and horizontal walls segments of carotid canals bilaterally and surrounds C4 segment of left ICA, infiltrating hiatus of pterygopalatine canal on the left. Tumor extends toward pontine cistern through clivus defect reaching right vertebral and basilar arteries. Mass causes extensive destruction of the body of sphenoid bone, occipital bone clivus and petrous apex bilaterally.
Left ICA curves and loops toward submucosa in the Rosenmüller fossa.
CT reveals heterogeneous left II B node consistent with metastases. Other nodes are homogeneous in density.
On the left middle ear and mastoid air cells are opacified.
Conclusion: findings are suggestive of advanced nasopharynx cancer with metastases to left level II B lymph node, differentials are plasmacytoma and chordoma.
Biopsy confirmed nasopharynx carcinoma.