Nasopharyngeal carcinoma with perineural spread

Case contributed by Amr Farouk

Presentation

One year history of difficulty breathing, multiple right ear infections and growing lump at the right side of neck.

Patient Data

Age: 30 years old
Gender: Male
  • Irregular asymmetrical soft tissue mass is seen involving the right nasopharyngeal region obliterating both fossae of Rosenmuller. It is seen more sizable at the right aspect eliciting intermediate T1/T2 signal with avid homogeneous contrast uptake. Anteriorly and superiorly It is seen reaching the right pterygoid plates that appear more sclerotic associated with altered marrow signal at the right aspect of the clivus showing postcontrast enhancement and enhancement of the most medial part of the related medial pterygoid muscle. Laterally It is seen encroaching upon the para-pharyngeal space. Inferiorly it is seen merging with sizable right sided retropharyngeal pathologically enlarged lymph node measuring about 5 cm along its CC dimension and seen encroaching upon the related air way. Posteriorly it is seen inseparable from the longus colli muscle at the right side.  
  • The thin enhancing sheet is seen extending from the right aspect of the mass through slightly widened right foramen ovale (perineural spread along the mandibular division of the right trigeminal nerve).
  • Multiple metastatic pathologically enlarged right cervical lymph nodes.
  • Right side oto-mastoiditis is noted.
Annotated image

Encircled area showing the perineural spread of of the tumor along the right foramen ovale 

Case Discussion

Nasopharyngeal mass with clivus and pterygoid plates infiltration and perineural spread along the right foramen ovale.

Pathology obtained from right upper deep cervical lymph node showed cores of lymphoid tissue showing cohesive sheets and groups of large cells having moderately abundant cytoplasm and pleomorphic vesicular nuclei with prominent nucleoli exhibiting moderate mitosis. Tumors cells show positive cytoplasmic staining for (CK).

Final pathology diagnosis: undifferentiated carcinoma. 

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