Nasopharyngeal carcinoma with skull base invasion

Case contributed by Dr Ian Bickle

Presentation

Teenager with left level V mass. One week history given. On fibroscopy adenoidal tissue and left nasal polyp. Bled on touch.

Patient Data

Age: 15 years
Gender: Male

Large well defined enhancing mass centred on the left fossa of Rosenmuller with bulk dimensions of 5.4 x 4.4cm.  The mass extends inferiorly on the left to the oropharynx and superiorly into and almost completely filling the sphenoid sinus.  On the left the tumour involves the posterior nasal canal.

The mass crosses right of the midline at the level of the nasopharynx and on the left abuts 180 degrees of the internal carotid artery.

A 8 mm tongue of tissue extends into and widens the left sphenopalatine foramen and pterygopalatine fossa into the pterygomaxillary tissue.

Pituitary fossa and floor of the anterior cranial fossa are intact.  The left medial pterygoid plate and posterior aspect of the bone nasal septum is irregular with cortical disruption.

Obstructive fluid in the left maxillary sinus.  Obstructive fluid in the left mastoid due to Eustachian tube obstruction from the mass.

Malignant 4.9 cm left level V nodes with some smaller adjacent sub-centimetre nodes.

Left level III nodes up to 15 mm.    Left 1B up to 13 mm.

Large well defined enhancing mass centred on the left fossa of Rosenmuller with bulk dimensions of 5.4 x 4.4 cm.  The mass extends inferiorly to the oropharynx and superiorly into and almost completely filling the sphenoid sinus.  On the left the tumour involves the posterior nasal canal.

The mass crosses right of the midline at the level of the nasopharynx and on the left abuts 180 degrees of the internal carotid artery.

A 8mm tongue of tissue extends into and widens the left sphenopalatine foramen and pterygopalatine fossa into the pterygomaxillary tissue.

Pituitary fossa and floor of the anterior cranial fossa are intact.  The left medial pterygoid plate and posterior aspect of the bone nasal septum is irregular with cortical disruption.

Obstructive fluid in the left maxillary sinus.  Obstructive fluid in the left mastoid due to Eustachian tube obstruction from the mass.

Malignant 4.9 cm left level V nodes with some smaller adjacent sub-centimetre nodes.

Left level III nodes up to 15 mm.    Left 1B up to 13 mm.

 

Case Discussion

This teenage patient presented with advanced nasopharyngeal metastatic disease. 

The case demonstrates the combined value to MRI and CT in head and neck malignancies, especially those involving the skull base.

The anatomical spaces of the head and neck are well demonstrated on this case in particular the sphenopalatine foramen and pterygopalatine fossa, as the tumour extends into the expands these spaces.

Ultrasound guided biopsy of the neck node was undertaken.

HISTOLOGY: Metastatic undifferentiated carcinoma

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Case information

rID: 53415
Case created: 17th May 2017
Last edited: 1st Jun 2017
System: Head & Neck
Inclusion in quiz mode: Included

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