Nasopharyngeal carcinoma - non keratising
2 month history of increased nasal congestion and headache with associated increased hyponasal voice.
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Contrast enhanced CT of the neck demonstrates a very large heterogeneously enhancing mass of the nasopharynx extending into and through the clivus and down to the C1 anterior arch / dens.
The patient went on to have a nasopharyngeal biopsy which demonstrated invasive non-keratinizing squamous cell carcinoma.
It is staggering how large some base of skull tumours can before coming to clinical attention.