Nasopharyngeal carcinoma

Case contributed by Dr Safwat Mohammad Almoghazy

Presentation

Nasal stuffiness.

Patient Data

Age: 30 years
Gender: Female
MRI

A large abnormal signal intensity nasopharyngeal mass lesion bilaterally obliterating
the fossae of Rosenmuller with the following relation:

  • Anteriorly the mass is protruding in the posterior aspect of the nasal cavity more on the left side.
  • Posteriorly the mass is seen infiltrating the prevertebral muscles.
  • Laterally the mass show extension to the para-pharyngeal space with an involvement of the medial pterygoid muscles.
  • Superiorly the mass abuts the clivus and the floor of the sphenoid, however no definite evidence of overt extension.
  • Inferiorly, the mass abuts the oropharynx. No evidence of intracranial / peri neural extension.

The mass is eliciting intermediate T1/ T2 signals and shows intense heterogeneous
postcontrast enhancement with evidence of diffusion restriction with estimated ADC= 0.5.

Retained fluid secretions are noted at the left maxillary, ethmoidal and sphenoidal sinuses as well as the nasal cavity.

Multiple enlarged bilateral cervicals and left supraclavicular lymph nodes noted most of them show necrotic changes and evidence of diffusion restriction. The largest seen on the left side.
Bilateral retropharyngeal necrotic.

Other visualized neck structures are unremarkable. Normal marrow signal of the visualized bones.

Impression:

Baseline study for a known case of nasopharyngeal carcinoma showing large nasopharyngeal mass and bilateral metastatic cervical and left supraclavicular lymphadenopathy suggesting stage T2N3bMx.

Case Discussion

This  middle age female patient was diagnosed with nasopharyngeal carcinoma (NPC) by endoscopic biopsy and referred for MRI evaluation and was MRI done as above mentioned

MRI is essential for detection of early NPC, staging of the primary tumor, and evaluation of associated retropharyngeal and cervical lymphadenopathy. It has been used for monitoring patients after therapy to detect tumor recurrence and radiation associated changes in the soft tissue and bone.

Imaging is valuable for the differentiation of NPC from other similar lesions.

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Case information

rID: 54550
Case created: 14th Jul 2017
Last edited: 18th Jul 2017
Inclusion in quiz mode: Included

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