Presentation
Nasal stuffiness.
Patient Data
Large abnormal signal intensity nasopharyngeal mass lesion obliterating
the fossae of Rosenmuller bilaterally with the following relations:
- 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 parapharyngeal space with an involvement of the medial pterygoid muscles
- superiorly the mass abuts the clivus and the floor of the sphenoid, however there is no definite evidence of overt extension
- inferiorly, the mass abuts the oropharynx with no evidence of intracranial/perineural extension
The mass elicits intermediate T1/T2 signal and shows intense heterogeneous
postcontrast enhancement with evidence of diffusion restriction.
Retained fluid secretions are noted at the left maxillary, ethmoidal and sphenoidal sinuses as well as the nasal cavity.
Multiple enlarged bilateral cervical and left supraclavicular lymph nodes, most of them with necrotic changes and evidence of diffusion restriction. The largest are seen on the left side.
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 aged female patient was diagnosed with nasopharyngeal carcinoma (NPC) by endoscopic biopsy and referred for MRI evaluation.
MRI is essential for detection of early NPC, staging of the primary tumor, and evaluation of associated cervical lymphadenopathy. It is also used to monitor patients after therapy, assess tumor recurrence and radiation associated changes in the soft tissue and bone, and differentiate NPC from other similar lesions.
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