Figure 1
Axial T1W SE before and after contrast
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)
References
[1]
James JM, Weill B, Bernadou A, Temim L, Tricot G, Diebold J, Zittoun R, Bilski-Pasquier G (1976)
Undifferentiated naso-pharyngeal carcinoma of the Schmincke-Regaud type. Apropos of 3 cases
Ann Med Interne 127(6-7):421-8. (PMID: 970804)
[2]
Saussez S, Heimann P, Vandevelde L, Bisschop P, Jortay A, Schandene L, Cogan E (1997)
Undifferentiated carcinoma of the nasopharynx and leukemoid reaction: report of case with literature review.
J Laryngol Otol 111(1):66-9. (PMID: 9292137)
[3]
Resa L, Ricco R, Santangelo A (1983)
Morphologic and classificatory considerations about 140 cases of carcinoma of the nasopharynx.
Tumori 69(4):313-21. (PMID: 6312650)
Case information
| URL: | https://www.eurorad.org/case/71 |
| DOI: | 10.1594/EURORAD/CASE.71 |
| ISSN: | 1563-4086 |
Figure 2
Post-contrast (Gd IV) coronal sections, T1W SE
Note the filling of the nasal fossa and the retention changes in the left maxillary sinus
Note the disruption of the posterior inner wall of the left maxillary antrum, as the deep posterior extension
There was a disruption of the skull base around the left foramen ovale, involvement of the cavernous sinus and encasement of the left internal carotid artery
Same comments as 1c
Axial T1W SE before and after contrast
Post-contrast (Gd IV) coronal sections, T1W SE
Note the filling of the nasal fossa and the retention changes in the left maxillary sinus
Note the disruption of the posterior inner wall of the left maxillary antrum, as the deep posterior extension
There was a disruption of the skull base around the left foramen ovale, involvement of the cavernous sinus and encasement of the left internal carotid artery
Same comments as 1c