CASE 71 Published on 16.01.2000

Nasopharyngeal carcinoma of the Regaud type

Section

Head & neck imaging

Case Type

Clinical Cases

Authors

Lemort M, Leurquin M

Patient

32 years, male

Categories
No Area of Interest ; Technique MR, MR
Clinical History
Large tumour of the nasopharynx found after complaints of persistant facial pain
Imaging Findings
This patient, a woodworker, was referred in our institution for staging of a large rhinopharyngeal tumour discovered after persistent pain following extraction of a right superior molar tooth. A trigeminal neuralgy was already diagnosed. A MR examination is performed using following sequences : T1w SE axial and frontal pre and post Gd DOTA, T2w SE axial. Where is the posterior limit of the lesion ? What about the masticator space ? Is there any intracranial extension ? How do you explain the high signal on the T2w images of the mastoid cells ?
Discussion
Both the retropharyngeal spaces and the left prevertebral space are involved. The tumour infiltrates the masticator space with a perineural extension around the V3 nerve up to Meckel's cave. The intracranial extension follows a perineural way (V3 --> foramen ovale --> Meckel's cave) and a contiguous way through the sphenoid sinus. The hypersignal in the mastoid cells is caused by middle-ear fluid resulting from Eustachian tube malfunction (probably due to a tumour infiltration of the torus tubarii). Diagnosis was confirmed by biopsy : nasopharyngeal epithelioma (Regaud type). This refers to an undifferenciated nasopharyngeal carcinoma with foci of cells from epithelial origin (ref.1-3). The patient was only partially treated by chemo- and radiotherapy because he was lost of follow-up.
Differential Diagnosis List
Undifferenciated nasopharyngeal carcinoma (Regaud type)
Final Diagnosis
Undifferenciated nasopharyngeal carcinoma (Regaud type)
Case information
URL: https://www.eurorad.org/case/71
DOI: 10.1594/EURORAD/CASE.71
ISSN: 1563-4086