Presentation
Left sided hearing loss and horizontal diplopia.
Patient Data
Extensive predominantly left sided nasopharyngeal mass invades the left infra-temporal masticator space.
Invasion of the clivus and the anterior margin of the foramen magnum is associated with abnormal dural enhancement.
Extension along the left V3 nerve through foramen ovale to Meckel's
Enhancing tumour surrounds the left internal carotid artery at the skull base and areas thickening of the left cavernous
Likely extension anteriorly along the left V1 and V2 into the left orbit.
No perineural spread on the right.
Lymphadenopathy:
- 2x left level 2a lymph nodes are likely mets (14x9, 13x10mm). The more posterior of these possibly has central necrosis and extracapsular invasion.
- A right level 2a node is rounded and suspicious for metastasis.
Case Discussion
Case submitted by Dr Smita Deb and A/Prof Pramit Phal.
Staging:
T4- tumour has intracranial extension plus invasion of the masticator space and cranial nerves.
N2- bilateral metastasis in lymph nodes <6cm above the supraclavicular fossa.
Histology of the nasopharyngeal mass which was biopsied from both sides confirmed undifferentiated non-keratinising NPC. USS +/- FNA of the lymph nodes could confirm metastasis.
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