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Nasopharyngeal Carcinoma

Williams LLW - MedPix (2011)

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Nasopharyngeal Carcinoma

History: 38 y/o man has swelling in right side of his neck which developed several weeks previously. He states it's nontender, nonpulsatile, and doesn't really bother him. He denies hoarsness, dysphagia, or dyspnea. Denies any recent trauma to the neck or recent illness. No fevers, chills, night sweats, weight loss.

Findings: MRI neck mass: Just deep to the right sternomastoid muscle is a T1 dark T2 bright fluid collection measuring 4.5 cm in craniocaudal dimension by 3.3 cm AP by 2.6 cm transverse. The wall is thin and demonstrating mild enhancement, but no internal enhancement is noted. No additional adenopathy in the neck is noted. CT neck s/p excisional biopsy of neck mass: Nasopharyngeal mass measures 1.6 x 1.8 cm anterior to posterior x 1.5 cm superior to inferior. Enlarged lymph node at C2 vertebral level in left parapharyngeal space measuring 1.8cm on long axis. There are surgical changes in the right neck, consistent with the resected metastatically enlarged right level 5 lymph node. There is air/gas and fluid in the resection site. NM-PET s/p excisional biopsy of neck mass: 1) Extending from the fossa of Rosenmueller in the right nasopharyngeal space is an irregular mass which measures approximately 2.6 x 1.7 cm and demonstrates avid FDG uptake with an SUV of 12.3. There is an enlarged level II lymph node on the left just adjacent to the oropharynx which demonstrates FDG uptake with an SUV of 8.0. Additionally, several small level V lymph nodes also seen on the left which demonstrate mild FDG uptake with SUV of 2.5. 2) Surgical changes are seen on the right in the region of the angle of the mandible adjacent to the right sternocleidomastoid muscle to include soft tissue emphysema, inflammatory fat stranding, and mild FDG uptake in this region. Focal region of FDG uptake with an SUV of 5.0 likely represents lymph node which may represent metastatic focus or may be reactive in nature. No other enlarged or FDG avid lymph nodes are seen.

Ddx: • Brachial Cleft Cyst • Reactive lymphadenopathy • Mononucleosis • Peritonsilar/retropharyngeal abscess • Warthins tumor • Nasopharyngeal Carcinoma • Hodgkins Lymphoma

Dxhow: Biopsy

Exam: GEN: Alert, orientedx3. NAD Head: ATNC Eyes: EOMI, PERRLA Ears: TM's clear, w/o erythema/bulging, +LR, +LM sign, mobile Nose: Nares patent, turbinates non-swollen Throat: Swelling right nasopharynx. Well mucolized, no ulcerations, non-exophytic. Neck: 2-3cm firm neck mass posterior to mandible, mobile, nontender, non pulsatile. Heart: RRR, norm S1,S2. no m/r/g Lung: CTAB no w/r/r Abd: nondistended, soft nontender, no organomegaly, masses Ext: No c/c/e Neuro: CNII-XII grossly intact

No MeSH data available.


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Nasopharyngeal Carcinoma

Williams LLW - MedPix (2011)

© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX2473&req=5

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Nasopharyngeal Carcinoma

History: 38 y/o man has swelling in right side of his neck which developed several weeks previously. He states it's nontender, nonpulsatile, and doesn't really bother him. He denies hoarsness, dysphagia, or dyspnea. Denies any recent trauma to the neck or recent illness. No fevers, chills, night sweats, weight loss.

Findings: MRI neck mass: Just deep to the right sternomastoid muscle is a T1 dark T2 bright fluid collection measuring 4.5 cm in craniocaudal dimension by 3.3 cm AP by 2.6 cm transverse. The wall is thin and demonstrating mild enhancement, but no internal enhancement is noted. No additional adenopathy in the neck is noted. CT neck s/p excisional biopsy of neck mass: Nasopharyngeal mass measures 1.6 x 1.8 cm anterior to posterior x 1.5 cm superior to inferior. Enlarged lymph node at C2 vertebral level in left parapharyngeal space measuring 1.8cm on long axis. There are surgical changes in the right neck, consistent with the resected metastatically enlarged right level 5 lymph node. There is air/gas and fluid in the resection site. NM-PET s/p excisional biopsy of neck mass: 1) Extending from the fossa of Rosenmueller in the right nasopharyngeal space is an irregular mass which measures approximately 2.6 x 1.7 cm and demonstrates avid FDG uptake with an SUV of 12.3. There is an enlarged level II lymph node on the left just adjacent to the oropharynx which demonstrates FDG uptake with an SUV of 8.0. Additionally, several small level V lymph nodes also seen on the left which demonstrate mild FDG uptake with SUV of 2.5. 2) Surgical changes are seen on the right in the region of the angle of the mandible adjacent to the right sternocleidomastoid muscle to include soft tissue emphysema, inflammatory fat stranding, and mild FDG uptake in this region. Focal region of FDG uptake with an SUV of 5.0 likely represents lymph node which may represent metastatic focus or may be reactive in nature. No other enlarged or FDG avid lymph nodes are seen.

Ddx: • Brachial Cleft Cyst • Reactive lymphadenopathy • Mononucleosis • Peritonsilar/retropharyngeal abscess • Warthins tumor • Nasopharyngeal Carcinoma • Hodgkins Lymphoma

Dxhow: Biopsy

Exam: GEN: Alert, orientedx3. NAD Head: ATNC Eyes: EOMI, PERRLA Ears: TM's clear, w/o erythema/bulging, +LR, +LM sign, mobile Nose: Nares patent, turbinates non-swollen Throat: Swelling right nasopharynx. Well mucolized, no ulcerations, non-exophytic. Neck: 2-3cm firm neck mass posterior to mandible, mobile, nontender, non pulsatile. Heart: RRR, norm S1,S2. no m/r/g Lung: CTAB no w/r/r Abd: nondistended, soft nontender, no organomegaly, masses Ext: No c/c/e Neuro: CNII-XII grossly intact

No MeSH data available.