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MRI through the nasopharynx and base of skull of an Asian patient including contrast enhanced fat suppressed sequences demonstrates a large nasopharyngeal mass invading the cavernous sinuses (especially on the left), clivus and pterygopalatine fossa. Large right sided lymph nodes are present.
Features are consistent with a nasopharyngeal carcinoma, which was confirmed on biopsy (non-keratinizing squamous cell carcinoma, EBV positive).
Both biopsies show similar features, with invasive poorly differentiated non-keratinizing squamous cell carcinoma involving fragments of soft tissue and bone. The tumor is positive for EBV by in situ hybridization for EBER. EBV is highly associated with nasopharyngeal carcinoma.