Presentation
Right upper neck mass with a progressive course. Difficult swallowing
Patient Data
Asymmetrical enhancing soft tissue thickening of right nasopharyngeal wall obliterating right fossa of Rosen Moller with subsequent right mastoid and middle ear effusion. It measures 2.4x3.7 cm and shows restricted diffusion with ADC =0.7 x10-3 mm2. No definite intracranial extension or perineural spread.
Bilateral enlarged retropharyngeal, level II and left level III LNs. The most significant one is the left retropharyngeal region, measuring 3.2x3.8 cm.
Case Discussion
Pathologically proven undifferentiated non keratinized nasopharyngeal carcinoma WHO IIb.
Nasopharyngeal carcinoma rarely affects children. It is commonly diagnosed between 40 and 60 years old.
MRI is a sensitive diagnostic method to exclude perineural spread and intracranial extension.
Differential diagnosis includes:
- Hypertrophied adenoid tissue: preserved striped pattern on T2 images, no associated LN.
- Nasopharyngeal lymphoma: more symmetrical enlargement of the nasopharynx and multiple bulky cervical LNs.