Nasopharyngeal rhabdomyosarcoma

A soft tissue mass is present in the right nasopharyngeal mucosal space, compressing and displacing the paraphayrngeal fat space laterally. There is bony base of skull destruction superiorly.

A large heterogeneous right nasopharyngeal mass lesion is seen. It measures 5.8 X 3.6 X 3.4 cm in its main CC and axial diameters respectively. The lesion shows heterogeneously hypointense T1 and hyperintense T2 signal with intense heterogeneous post-contrast enhancement. 

The lesion encroaches upon the right para-pharyngeal fat planes and displaces it posterolaterally.
The lesion extends downwards in the right paravertebral space, it compresses and possibly infiltrates the right longus colli and right lateral pterygoid muscles. The lesion infiltrates the right sphenoidal air cells with destruction of its wall. The lesion encroaches upon the right cavernous sinus with encasement of petrous and cavernous right ICA. 

Associated opacification of right middle ear and mastoid air cells is seen, mostly due to obstruction / dysfunction of the right Eustachian tube. Clear rest of the para-nasal sinuses. 

Enlarged bilateral upper and lower deep cervical lymph nodes. 

Conclusion: 

Right nasopharyngeal aggressive and infiltrative mass lesion with mass effect and extension as described above; nasopharyngeal rhabdomyosarcoma with secretory serous otitis media and mastoiditis. Small bilateral cervical lymph nodes.