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Hypertrophic adenoids in patients with nasopharyngeal carcinoma: appearance at magnetic resonance imaging before and after treatment

View Article: PubMed Central

ABSTRACT

Introduction: Patients with nasopharyngeal carcinoma (NPC) sporadically develop abnormal adenoids. Nasopharyngeal adenoids are usually included in the gross tumor volume (GTV) but may have different therapeutic responses than tumor tissue. Therefore, distinguishing adenoids from tumor tissue may be required for precise and efficient chemoradiotherapy and radiotherapy. We characterized nasopharyngeal adenoids and investigated the therapeutic responses of NPC and nasopharyngeal adenoids using magnetic resonance imaging (MRI).

Methods: MRI data from 40 NPC patients with a coexisting adenoid mass before and after treatment were analyzed. The features of the adenoid masses, including location, striped appearance, size, interface, symmetry/asymmetry, and cysts, were evaluated. Treatment response were scored according to the World Health Organization guidelines.

Results: A striped appearance was observed in 36 cases before treatment and in all cases after treatment. In these 36 cases, the average GTVs including and excluding the uninvolved adenoids were 19.8 cm3 and 14.8 cm3, respectively. The average percentage change after excluding the uninvolved adenoids from the GTV was 31.0%. Stable disease in the adenoids was identified in 27 (96.4%) of 28 patients after neoadjuvant chemotherapy, while NPC clearly regressed. Partial adenoid responses were identified in 33 (82.5%) of 40 patients at 3 months after chemoradiotherapy or radiotherapy, whereas complete tumor responses were achieved in all patients. Six months after treatment, the adenoids continued to atrophy but did not disappear, and tumor recurrence was not found.

Conclusions: Nasopharyngeal adenoids and carcinoma tissue in NPC patients can be distinguished by using MRI and have different responses to chemoradiotherapy and radiotherapy. These findings contribute to better delineating the GTV of NPC, based on which spatially optimized strategies can be developed to render precise and efficient chemoradiotherapy and radiotherapy. Additionally, we observed a clear difference in the responses of these two tissue types to current therapies. This finding may reduce or avoid unnecessary biopsies or overtreatment.

No MeSH data available.


Related in: MedlinePlus

Treatment response, as determined by axial T1-weighted contrast-enhanced magnetic resonance imaging (MRI), in a 12-year-old nasopharyngeal carcinoma (NPC) patient with a small tumor coexisting with hypertrophic adenoids. A, before treatment, the NPC originated in the roof of the nasopharynx (short arrows) and could not be clearly distinguished from hypertrophic adenoids (long arrow). B, 10 days after the end of neoadjuvant chemotherapy, a partial response (PR) was achieved for the tumor (short arrows), and stripes (long arrow) became visible in hypertrophic adenoids. C, 3 months after the end of radiotherapy, a complete response (CR) was achieved for the tumor, a PR was demonstrated for hypertrophic adenoids, and the stripes on hypertrophic adenoids became more visible (long arrow). Note that hypertrophic adenoids were asymmetric (short arrow) most likely because of previous tumor invasion.
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Fig1: Treatment response, as determined by axial T1-weighted contrast-enhanced magnetic resonance imaging (MRI), in a 12-year-old nasopharyngeal carcinoma (NPC) patient with a small tumor coexisting with hypertrophic adenoids. A, before treatment, the NPC originated in the roof of the nasopharynx (short arrows) and could not be clearly distinguished from hypertrophic adenoids (long arrow). B, 10 days after the end of neoadjuvant chemotherapy, a partial response (PR) was achieved for the tumor (short arrows), and stripes (long arrow) became visible in hypertrophic adenoids. C, 3 months after the end of radiotherapy, a complete response (CR) was achieved for the tumor, a PR was demonstrated for hypertrophic adenoids, and the stripes on hypertrophic adenoids became more visible (long arrow). Note that hypertrophic adenoids were asymmetric (short arrow) most likely because of previous tumor invasion.

Mentions: All hypertrophic adenoids were located in the posterior superior nasopharyngeal wall and roof. Stripes could not be detected in 4 patients due to complete involvement by the tumor (Figure 1A), but were demonstrated in 36 patients before treatment (Figures 1B, C, 2, 3, 4 and 5). The mean greatest anteroposterior diameter of hypertrophic adenoids was 16 mm (range, 10–22 mm). The interface between hypertrophic adenoids and NPC was well-defined in 5 patients and ill-defined in 35 patients (Figure 2). Only 5 patients had hypertrophic adenoids with a symmetrical appearance. Nasopharyngeal cysts in hypertrophic adenoids were identified in 25 patients (62.5%). Thornwaldt cysts, which were identified by their midline location in the nasopharyngeal roof, were present in 2 patients (5.0%). Hypertrophic adenoids extending into the pharyngeal recess (Figures 2 and 3A) were detected in 26 patients (65.0%).Figure 1


Hypertrophic adenoids in patients with nasopharyngeal carcinoma: appearance at magnetic resonance imaging before and after treatment
Treatment response, as determined by axial T1-weighted contrast-enhanced magnetic resonance imaging (MRI), in a 12-year-old nasopharyngeal carcinoma (NPC) patient with a small tumor coexisting with hypertrophic adenoids. A, before treatment, the NPC originated in the roof of the nasopharynx (short arrows) and could not be clearly distinguished from hypertrophic adenoids (long arrow). B, 10 days after the end of neoadjuvant chemotherapy, a partial response (PR) was achieved for the tumor (short arrows), and stripes (long arrow) became visible in hypertrophic adenoids. C, 3 months after the end of radiotherapy, a complete response (CR) was achieved for the tumor, a PR was demonstrated for hypertrophic adenoids, and the stripes on hypertrophic adenoids became more visible (long arrow). Note that hypertrophic adenoids were asymmetric (short arrow) most likely because of previous tumor invasion.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4593340&req=5

Fig1: Treatment response, as determined by axial T1-weighted contrast-enhanced magnetic resonance imaging (MRI), in a 12-year-old nasopharyngeal carcinoma (NPC) patient with a small tumor coexisting with hypertrophic adenoids. A, before treatment, the NPC originated in the roof of the nasopharynx (short arrows) and could not be clearly distinguished from hypertrophic adenoids (long arrow). B, 10 days after the end of neoadjuvant chemotherapy, a partial response (PR) was achieved for the tumor (short arrows), and stripes (long arrow) became visible in hypertrophic adenoids. C, 3 months after the end of radiotherapy, a complete response (CR) was achieved for the tumor, a PR was demonstrated for hypertrophic adenoids, and the stripes on hypertrophic adenoids became more visible (long arrow). Note that hypertrophic adenoids were asymmetric (short arrow) most likely because of previous tumor invasion.
Mentions: All hypertrophic adenoids were located in the posterior superior nasopharyngeal wall and roof. Stripes could not be detected in 4 patients due to complete involvement by the tumor (Figure 1A), but were demonstrated in 36 patients before treatment (Figures 1B, C, 2, 3, 4 and 5). The mean greatest anteroposterior diameter of hypertrophic adenoids was 16 mm (range, 10–22 mm). The interface between hypertrophic adenoids and NPC was well-defined in 5 patients and ill-defined in 35 patients (Figure 2). Only 5 patients had hypertrophic adenoids with a symmetrical appearance. Nasopharyngeal cysts in hypertrophic adenoids were identified in 25 patients (62.5%). Thornwaldt cysts, which were identified by their midline location in the nasopharyngeal roof, were present in 2 patients (5.0%). Hypertrophic adenoids extending into the pharyngeal recess (Figures 2 and 3A) were detected in 26 patients (65.0%).Figure 1

View Article: PubMed Central

ABSTRACT

Introduction: Patients with nasopharyngeal carcinoma (NPC) sporadically develop abnormal adenoids. Nasopharyngeal adenoids are usually included in the gross tumor volume (GTV) but may have different therapeutic responses than tumor tissue. Therefore, distinguishing adenoids from tumor tissue may be required for precise and efficient chemoradiotherapy and radiotherapy. We characterized nasopharyngeal adenoids and investigated the therapeutic responses of NPC and nasopharyngeal adenoids using magnetic resonance imaging (MRI).

Methods: MRI data from 40 NPC patients with a coexisting adenoid mass before and after treatment were analyzed. The features of the adenoid masses, including location, striped appearance, size, interface, symmetry/asymmetry, and cysts, were evaluated. Treatment response were scored according to the World Health Organization guidelines.

Results: A striped appearance was observed in 36 cases before treatment and in all cases after treatment. In these 36 cases, the average GTVs including and excluding the uninvolved adenoids were 19.8 cm3 and 14.8 cm3, respectively. The average percentage change after excluding the uninvolved adenoids from the GTV was 31.0%. Stable disease in the adenoids was identified in 27 (96.4%) of 28 patients after neoadjuvant chemotherapy, while NPC clearly regressed. Partial adenoid responses were identified in 33 (82.5%) of 40 patients at 3 months after chemoradiotherapy or radiotherapy, whereas complete tumor responses were achieved in all patients. Six months after treatment, the adenoids continued to atrophy but did not disappear, and tumor recurrence was not found.

Conclusions: Nasopharyngeal adenoids and carcinoma tissue in NPC patients can be distinguished by using MRI and have different responses to chemoradiotherapy and radiotherapy. These findings contribute to better delineating the GTV of NPC, based on which spatially optimized strategies can be developed to render precise and efficient chemoradiotherapy and radiotherapy. Additionally, we observed a clear difference in the responses of these two tissue types to current therapies. This finding may reduce or avoid unnecessary biopsies or overtreatment.

No MeSH data available.


Related in: MedlinePlus