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    Go to the top of the page   ID: 20110222134054 Original case in english  More links about this topic on Pubmed (PubMed Reader)
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    Nasopharyngeal carcinoma
    Matt Cherry. Nasopharyngeal carcinoma. PedRad [serial online] vol 11, no. 2.
    URL: www.PedRad.info/?search=20110222134054


     
     Pediatric Radiology CasesImages to this case: There are CT-images available for this case. [ CT ] There are MRI-images available for this case. [ MRI ] There are Nuclearmedicine-images available for this case. [ Nuclearmedicine ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    Matt Cherry (University of Missouri/Columbia/USA)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    16 Years  

     
     Pediatric Radiology CasesGender:

    Male  

     
     Pediatric Radiology CasesRegion-Organ:

    Head-Nose  

     
     Pediatric Radiology CasesMost likely etiology:

    neoplastic  

     
     Pediatric Radiology CasesHistory:

    16 year old male presented to the Emergency Room complaining of fatigue and increasing nosebleeds over the past month. His hemoglobin was found to be 6.8. Past medical history was significant for chronic epistaxis and chronic headaches.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    Undifferentiated nasopharyngeal carcinoma.  

     
     Pediatric Radiology CasesRadiological findings:


    CT 1 <- view CT 1

    CT 1: Noncontrast axial CT demonstrating an oval soft tissue density mass in the left posterior nasopharyngeal region that slightly crosses midline.






    CT 2 <- view CT 2

    CT 2: Noncontrast axial CT bone windows show erosion of the medial and lateral left pterygoid plates.






    MRI 1 <- view MRI 1

    MRI 1: Axial T1 post contrast image demonstrates the fairly well marginated mass with moderately increased signal and contrast enhancement.






    MRI 2 <- view MRI 2

    MRI 2: Coronal T1 post contrast fat suppressed image reveals no intracranial extension.






    MRI 3 <- view MRI 3

    MRI 3: Axial T2 precontrast image shows mildly increased signal in the posterior nasopharyngeal mass.






    Nuclearmedicine 1 <- view Nuclearmedicine 1

    Nuclearmedicine 1: (PET) Multiplanar images demonstrate intense FDG activity in the posterior nasopharyngeal mass. Questionable small foci of increased uptake noted in the bilateral posterior cervical regions were suspicious for nodal metastasis.


     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    Surgery / Histo  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    Juvenile Angiofibroma, Rhabdomyosarcoma, Lymphoma, Chronic rhinosinusitis, Allergic fungal rhinosinusitis, Polyposis  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    Further metastatic imaging workup included CT scans of the chest, abdomen, and pelvis which were negative. Bone scan was also negative. Cerebral angiogram was performed to evaluate for possible juvenile angiofibroma. The vascularity associated with the mass was noted to be decreased in comparison to what is typically seen for juvenile angiofibromas. Subsequently a nasal endoscopic biopsy was performed whiched revealed the pathology. Patient started chemoradiation treatments and responded favorably both clinically and on followup imaging.

    Nasopharyngeal carcinoma accounts for approximately 1% of all childhood malignancies, and nearly one third of childhood nasopharyngeal neoplasms. It may be related to Ebstein Barr virus infection, and the incidence varies according to geographic location. Approximately 1 in every 100,000 children are affected annually in North America and Europe. There is a bimodal age distribution, peaking in late childhood and adults aged 50-60 years. The World Health Organization (WHO) recognizes three subtypes: squamous cell carcinoma (typically found in adults), non-keratinizing carcinoma, and undifferentiated carcinoma (typically in pediatric patients). This tumor arises from the epithelial cells that cover the surfaces of the nasopharynx. It usually originates in the lateral wall of the nasopharynx, and can spread to the other lateral wall, to the skull base or palate, nasal cavity, and oropharynx. It typically metastasizes to cervical lymph nodes. Distant mets may occur in bone, lung, mediastinum, and rarely the liver. In childhood, the presence of metastatic disease in cervical lymph nodes at diagnosis does not adversely affect the prognosis. Factors associated with a poor prognosis include extent of the primary tumor, skull base involvement, and cranial nerve involvement. Symptoms may include pain, trismus, otitis media, neck mass, headache, nasal congestion/obstruction, nasal bleeding, hearing loss, and cranial nerve palsies. Surgical therapy for these patients is typically limited to a biopsy for tissue diagnosis. Nearly all tumors are unresectable due to the complex anatomical location of the disease. Use of combination radiation therapy and chemotherapy allows long-term survival rates of 55-80%.

     

     
     Pediatric Radiology CasesComments of the author about the case:

    N/A  

     
     Pediatric Radiology CasesFirst description / History:

    First described by Regaud and Schmincke in 1921.
     

     
     Pediatric Radiology CasesLiterature:

    1. Medline: Medline
    Bernadette Brennan
    Nasopharyngeal carcinoma
    Orphanet Journal of Rare Diseases, 2006

    2. Medline: Medline
    Inci Ayan
    Childhood nasopharyngeal carcinoma: from biology to treatment
    The Lancet Oncology, 2003

    3. Medline: Medline
    Arnold Paulino
    Nasopharyngeal cancer
    eMedicine, 2010
     

     
     Pediatric Radiology CasesKeywords:

    nasopharyngeal carcinoma, epistaxis, nosebleed, pediatric radiology, child, childhood, pediatric radiology  

     
     Pediatric Radiology Cases Cite this article:

    Matt Cherry. Nasopharyngeal carcinoma. PedRad [serial online] vol 11, no. 2.
    URL: www.PedRad.info/?search=20110222134054  

     
     Pediatric Radiology Cases Read similar articles: with corresponding keywords
    in the same field: Head-Nose
    or in the region: Head
    or in the tissue/organ: Nose
    or with the etiology: neoplastic
     
     Pediatric Radiology CasesImages to this case: There are CT-images available for this case. [ CT ] There are MRI-images available for this case. [ MRI ] There are Nuclearmedicine-images available for this case. [ Nuclearmedicine ] View all modalities [ All ]   
     
    Nasopharyngeal carcinoma
    Matt Cherry. Nasopharyngeal carcinoma. PedRad [serial online] vol 11, no. 2.
    URL: www.PedRad.info/?search=20110222134054


     

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    Nasopharyngeal carcinoma
    Other cases by these authors:

    Search Matt Cherry in Medline Matt Cherry (1)   

    Nasopharyngeal carcinoma  
     
    Nasopharyngeal carcinoma
    Matt Cherry. Nasopharyngeal carcinoma. PedRad [serial online] vol 11, no. 2.
    URL: www.PedRad.info/?search=20110222134054


     

    Which diagnosis have other collegues guessed?


    • Nasal polyp
      Votes: 1 (2 %)


    • Nasopharyngeal carcinoma
      Votes: 9 (25 %)


    • Juvenile angiofibroma
      Votes: 20 (55 %)


    • Rhabdomyosarcoma
      Votes: 4 (11 %)


    • Lymphoma
      Votes: 2 (5 %)



        Total answers: 36

     
    Nasopharyngeal carcinoma
    Matt Cherry. Nasopharyngeal carcinoma. PedRad [serial online] vol 11, no. 2.
    URL: www.PedRad.info/?search=20110222134054


     

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    Nasopharyngeal carcinoma
    Matt Cherry. Nasopharyngeal carcinoma. PedRad [serial online] vol 11, no. 2.
    URL: www.PedRad.info/?search=20110222134054


     




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