Aged ; Female ; Humans ; Nasopharyngeal Neoplasms ; diagnosis ; pathology

Diagnosis, Differential ; Female ; Humans ; Infant, Newborn ; Nasopharyngeal Neoplasms ; pathology ; surgery ; Polyps ; pathology ; surgery ; Teratoma ; pathology

Carcinoma ; complications ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; complications ; Parotid Gland ; pathology ; Parotid Neoplasms ; diagnosis ; secondary

BACKGROUNDDetection rate of retropharyngeal lymph node metastasis in patients with nasopharyngeal carcinoma (NPC) needs to be improved. The purpose of this study was to compare three magnetic resonance (MR) sequences for detecting lymph nodes in patients with NPC.

METHODSBetween July 2007 and March 2008, MR staging of pre-treated tumor was conducted on 120 patients with pathologically confirmed NPC. The outcome of three different sequences for MR NPC staging were compared: coronal short TI inversion recovery (STIR), axial proton density fat-suppressed (PDWI fs), and coronal contrast enhanced fast spin echo T1 weighted fat-suppressed (CE FSE T1WI fs). Nodal classification method (1999) was applied to count the number of retropharyngeal and cervical lymph nodes discovered by each MR sequence. Paired t tests were used for statistical analysis.

RESULTSA total of 2575 lymph nodes were found using coronal STIR sequence; 1816 lymph nodes for coronal CE FSE T1WI fs sequence and 2638 lymph nodes for axial PDWI fs sequence. Significant differences existed in the number of lymph nodes detected by axial PDWI fs and coronal CE FSE T1WI fs sequence (paired t test, P < 0.05), with the former sequence getting higher numbers. Statistical differences also existed between coronal STIR and coronal CE FSE T1WI fs sequence (paired t test, P < 0.05), with the former sequence getting higher numbers. No significant difference was found between coronal STIR sequence and axial PDWI fs sequence (paired t test, P > 0.05).

CONCLUSIONSFor the detection of retropharyngeal and cervical lymph nodes, coronal STIR sequence and axial PDWI fs sequence have similar performance and both sequences showed better detection than CE FSE T1WI fs sequence. Furthermore, by combining coronal STIR sequence and axial PDWI fs sequence, we can improve the detection of lymph nodes in NPC N-staging before treatment, especially for lymph nodes located in the thoracic entrance.

Carcinoma ; diagnosis ; pathology ; Contrast Media ; Humans ; Lymphatic Metastasis ; diagnosis ; Magnetic Resonance Imaging ; Nasopharyngeal Neoplasms ; diagnosis ; pathology ; Neoplasm Staging ; methods

Metastasis of nasopharyngeal carcinoma (NPC) to the dura, an extremely rare condition, can be symptomatically silent and mistaken for a benign entity radiographically. Missed diagnosis can lead to serious consequences or prove immediately fatal. We report a woman with dural metastasis of NPC that mimicked a meningioma on radiography. Craniectomy with tumour resection was performed due to rapid progression from the onset of symptoms to disability. The patient was still alive two years after surgery. This case emphasises the need to keep in mind the possibility of dural metastasis of NPC in patients with abnormal imaging features. This would not only avoid wrong and optimistic diagnosis, but also allow for appropriate treatment in a timely manner. To our knowledge, this is the first report of metastasis of NPC to the dura. We provide detailed information on the neoplastic lesion, which masqueraded as a benign entity and caused potentially fatal consequences.
Adult ; Brain Neoplasms ; diagnosis ; secondary ; surgery ; Carcinoma ; Diagnosis, Differential ; Disease Progression ; Dura Mater ; pathology ; Female ; Humans ; Magnetic Resonance Imaging ; Meningioma ; diagnosis ; pathology ; Nasopharyngeal Neoplasms ; diagnosis ; pathology ; Neoplasm Metastasis

OBJECTIVE: To analyze the feature of cranial nerve involvement in nasopharyngeal carcinoma (NPC) and its relationship with the prognosis. METHOD: A total of 1892 patients who were diagnosed as NPC in our hospital from January 2002 to December 2003, of which the cranial nerve involvement was 183 (9.6%) patients, were analyzed the effect of cranial nerve involvement on the prognosis. RESULT: The percentage of cranial nerve involvement was 9.4%. The 5 year overall survival rate was 61.0%, disease free survival rate was 55.3%, local relapse free survival rate was 75.2% and distant metastasis free survival rate was 73.4%. Periods of cranial nerve involvement, clinical stage, the diameter of the lymph nodes, involvement of cavernous sinus, and the level of the recovery of cranial nerve involvement were significantly associated with prognosis in univariate analysis(P < 0.05). With multivariate analysis, the recovery level of cranial nerve involvement was the independent factor that affected the 5-year overall survival (RR = 2.087). The diameter of the lymph nodes and involvement of cavernous sinus were the independent factors that affected the 5-year distant metastasis-free survival (RR = 1.954 and 2.136, respectively). CONCLUSION Periods of cranial nerve involvement and the level of the recovery of cranial nerve involvement were significantly correlated with prognosis. Involvement of cavernous sinus could increase the rate of distant metastasis.
Adolescent ; Adult ; Aged ; Cranial Nerves ; pathology ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; diagnosis ; pathology ; Neoplasm Staging ; Prognosis ; Young Adult

OBJECTIVE: To investigate the clinical characteristics, therapeutic efficacy and misdiagnosis status of sphenoid sinus malignant tumor in order to improve the diagnosis rate. METHOD: Analysing and summarizing 18 patients with sphenoid sinus malignant tumor in our department from 1996 to 2005. RESULT: The metastatic nasopharyngeal carcinoma is the most of sphenoid sinus malignant tumor,the second is chordocarcinoma and non-Hodgkin lymphoma, its clinical manifestation was headache (78%), sight alteration (50%), cranial nerve palsy (39%), nose bleed (11%); the clinical diagnosis rate was 56%. CONCLUSION The nasal endoscopy is the convention examination for these patients with sphenoid sinus malignant tumor whose imageology diagnosis is of limitation.
Adult ; Diagnostic Errors ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; diagnosis ; pathology ; Paranasal Sinus Neoplasms ; diagnosis ; Retrospective Studies ; Sphenoid Sinus ; pathology

Nasopharyngeal cancer (NPC) is a unique disease that shows clinical behaviour, epidemiology and histopathology that is different from that of other squamous cell carcinomas of the head and neck. Magnetic resonance imaging (MRI) is now the preferred imaging modality in the assessment and staging of NPC, especially in relation to its superior soft tissue contrast, ability to demonstrate perineural tumour spread, parapharyngeal space, bone marrow involvement and its ability to show the involvement of adjacent structures, such as the adjacent paranasal sinuses and intracranial extension. An understanding of its patterns of spread and the criteria used in the AJCC TNM staging system is important to relay the relevant information to the referring clinician, so that appropriate treatment planning decisions may be made. In this article, the various features of NPC that are pertinent to staging and treatment planning will be discussed, inclusive of locoregional spread, nodal involvement and metastatic disease.
Humans ; Magnetic Resonance Imaging ; Nasopharyngeal Neoplasms ; diagnosis ; pathology ; therapy ; Nasopharynx ; anatomy & histology ; Neoplasm Staging ; Positron-Emission Tomography

Adult ; Aged ; Carcinoma ; Humans ; Middle Aged ; Nasopharyngeal Neoplasms ; diagnosis ; pathology ; therapy ; Neoplasm Recurrence, Local ; therapy ; Salvage Therapy ; Young Adult

OBJECTIVE: To investigate the effects of situation of misdiagnosis of nasopharyngeal carcinoma (NPC) on distant metastasis. METHOD: The history of diagnosis and treatment of 85 newly diagnosed cases with nasopharyngeal carcinoma were studied by using itemized questionnaire purposely; 433 patients with different prognosis were analyzed retrospectively for the misdiagnoses and mistreatment, including surgical biopsy in the neck. RESULT: (1) The rate of misdiagnosis of 85 patients was 72.64%, and the percentage decreased as the level of the hospitals increased; the majority of the patients (77.36%) were diagnoses within 1 month after the first symptom had appeared; the number of diseases misdiagnosed was 20, most common of which were lymphnoditis, tuberculosis of lymph node and secretory tympanitis; (2) Our data showed that among 433 patients analysed retrospectively, 60 cases had undergone surgical biopsy in the neck, 75% of whom had never received nasopharyngeal biopsy; 43 cases had underwent nasopharyngeal biopsy after the pathological diagnosis as metastatic carcinoma of neck biopsy (71.67%) and the rest (20.0%) received radiotherapy directly or after negative nasopharyngeal biopsy for merely 1 to 4 times; of those 43 cases who were diagnosed as NPC by nasopharyngeal biopsy, 79.17% got positive results at first sampling. (3) Rate of misdiagnosis and mistreatment including surgical biopsy in the neck of patients who had been tumor-free for 5 years or above was significantly lower than that of those who experienced distant metastasis after or before treatment (P < 0.05). CONCLUSIONS Misdiagnosis and mistreatment including biopsy by surgery of neck is common even in high-grade hospitals; it is doctor that is responsible for this situation; the high occurrence rate of misdiagnosis and mistreatment, biopsy by neck surgery, especially the delayed treatment after the neck biopsy are the factors that contribute to distant metastasis of NPC.
Diagnostic Errors ; Humans ; Nasopharyngeal Neoplasms ; diagnosis ; pathology ; therapy ; Neoplasm Metastasis ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Treatment Outcome