Metastatic tumors in the sellar and parasellar regions are uncommon and rarely detected in clinical practice. We present four cases of sellar and parasellar metastatic tumors, which metastasized from distant organ in one case and extended directly from adjacent structures in three. Common presenting symptoms were cranial neuropathies, headache and facial pain. Invasion into the cavernous sinus was noted in all cases. We report rare cases of sellar and parasellar metastases. Also, we should consider the possibility of metastasis in these regions for patients who showed the above clinical presentations in systemic cancer patients. In extensive diseases, transient symptomatic relief could be obtained by direct surgical management, even in restricted degree.
Adenocarcinoma/therapy ; Adenocarcinoma/radiography ; Adenocarcinoma/pathology* ; Adult ; Breast Neoplasms/radiography ; Breast Neoplasms/pathology* ; Carcinoma, Infiltrating Duct/therapy ; Carcinoma, Infiltrating Duct/radiography ; Carcinoma, Infiltrating Duct/pathology* ; Case Report ; Female ; Human ; Magnetic Resonance Imaging/methods ; Male ; Middle Age ; Nasopharyngeal Neoplasms/therapy ; Nasopharyngeal Neoplasms/radiography ; Nasopharyngeal Neoplasms/pathology* ; Palatal Neoplasms/therapy ; Palatal Neoplasms/radiography ; Palatal Neoplasms/pathology* ; Sella Turcica* ; Skull Neoplasms/therapy ; Skull Neoplasms/secondary* ; Skull Neoplasms/physiopathology

Tumor bulk has been recognized as an important prognostic factor in the treatment of malignancy. The purpose of the present study is to investigate the prognostic value of tumor volume in nasopharyngeal carcinoma. Sixty patients with nasopharyngeal carcinoma were included in this study. Tumor contour was outlined on each of the computed tomography (CT) images using an image analyzer. The primary tumor volume (PTV) and nodal tumor volume (NTV) were calculated by a summation-of-areas technique, and the maximal perimeter of primary tumor (MPP) was measured. The loco-regional control rates and disease-specific survival rates were analyzed according to several variables. The patients had a 5-year local control rate of 75.5%, 5-year nodal control rate of 74.6%, and 5-year disease-specific survival rate of 60.2%. Large PTV (> 30cm3) was associated with a significantly lower local control (p=0.005). Large NTV (> 5cm3) was associated with a significantly lower nodal control (p=0.019) and lower disease- specific survival (p=0.046). Large MPP (> 18cm) was associated with a significantly lower local control (p=0.017). In multivariate analysis, the PTV and NTV were found to be independent factors in predicting the local (p=0.015) and nodal (p=0.039) control, respectively. The NTV (p=0.012) and cranial nerve involvement (p=0.009) were factors that predicted disease-specific survival. Our results suggest that the estimation of tumor volume may identify a subgroup of patients with a greater risk of loco-regional failure and can be used to refine the current staging system.
Adult ; Aged ; Carcinoma/pathology/*radiography ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms/pathology/*radiography ; Neoplasm Staging ; Prognosis ; *Tomography, X-Ray Computed

OBJECTIVETo evaluate salvage surgical approaches and efficacy for post-radiation local recurrent nasopharyngeal carcinoma (NPC).

METHODSThirteen patients with post-radiation local recurrent NPC underwent salvage surgical treatment by routes as transpalatal approach, nasal medial swing approach, maxillary swing approach and infratemporal fossa approach. All cases were followed up for 2 to 5 years. Analysis was done on the indications and efficacy of these 4 different approaching routes.

RESULTSNo immediate operative complications occurred for all these 13 cases. Four patients with T1 and T2a operated via transpalatal approach and nasal medial swing approach survived more than 3 years. Five patients with T2b and T3 operated via maxillary swing approach. Among them, two patients died at second and 24th month after operation, one survived with tumor and died at 13rd month after operation, two were alive free of tumor for 2 and 4 years after operation. Four patients with T4 operated via infratemporal fossa approach. Among them, three died in 1 year, one was alive free of tumor for 2 years.

CONCLUSIONSSurgical approaches were decided by a comprehensive consideration of recurrent tumor site and invasive range to achieve the best operative site exposure with minimal traumatic damage.

Adult ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; diagnostic imaging ; pathology ; Neoplasm Recurrence, Local ; surgery ; Radiography ; Salvage Therapy

OBJECTIVETo investigate the safety and efficacy of percutaneous incisional needle biopsy (PINB) in the parapharyngeal region under CT guide for highly suspicious nasopharyngeal carcinoma (NPC) or recurrence of NPC after radiotherapy.

METHODSPINB under CT guide was performed in 32 highly suspicious NPC or recurrence of NPC after radiotherapy through three puncture routes: posterolateral maxillary sinus fatty area, mandibular fossa area, and anterior-mastoid area. Specimens were fixed by 95% alcohol and then underwent pathologic examination.

RESULTSCT guided PINB was successfully performed in every patients with a technical successful rate of 100%. Definitive histopathologic diagnosis was obtained in 30 patients: squamous-cell carcinoma 21, undifferentiated carcinoma 5 and adenocarcinoma 4. The remaining two negative cases were confirmed as fibrosis after radiotherapy. Complications included persistent bleeding of puncture point in one patient and bloody sputum in 3 patients which subsided after symptomatic management. None of these patients was found to have symptoms of nerve injury caused by PINB procedure.

CONCLUSIONThe CT guided percutaneous incisional needle biopsy in parapharyngeal region through the above three puncture routes for highly suspicious nasopharyngeal carcinoma is safe, rapid and effective.

Adult ; Aged ; Biopsy, Needle ; methods ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; pathology ; Pharynx ; diagnostic imaging ; pathology ; Radiography, Interventional ; Tomography, X-Ray Computed

Hypertrophic osteoarthropathy is characterized by clubbing of the digital tips and periosteal reaction of long bones. Most of the cases are associated with malignancy or other conditions such as congenital heart disease, liver cirrhosis, pulmonary fibrosis, biliary atresia, and gastrointestinal polyps. Hypertrophic osteoarthropathy associated with malignancy is rare in children. A few cases of hypertrophic osteoarthropathy in children with nasopharyngeal carcinoma have been reported, however, there has been no report of such case in Korea. We present a case of hypertrophic osteoarthropathy associated with nasopharyngeal carcinoma with lung metastasis in a 14-yr-old boy. In this case, hypertrophic osteoarthropathy regressed after intensive chemotherapy, but subsequently the patient died of progressive lung metastasis.
Adolescent ; Bone and Bones/radiography ; Carcinoma/*diagnosis/mortality ; Disease Progression ; Fatal Outcome ; Human ; Joint Diseases/pathology ; Lung Neoplasms/mortality/*secondary ; Male ; Nasopharyngeal Neoplasms/*diagnosis/mortality ; Neoplasm Metastasis ; Osteoarthropathy, Primary Hypertrophic/*diagnosis/mortality/radiography ; Prognosis

BACKGROUNDNasopharygeal fibroangioma (NPF) can be approached through lateral rhinotomy, the middle skull fossa approach and the transcranial-facial combined approach. It is complicated and thus results in more insults, and when adopted, the total resection rate of tumor is still low. The nasal endoscope is minimally invasive, the dead angles of a craniotomy, such as sphenoid sinus, maxillary sinus, and nasopharynx are easily approached by an endoscope. Lateral rhinotomy have to make facial incision and affects maxillary bone development. We combined the craniotomy and endoscopic approach intending to take advantages of the two approaches.

METHODSTwelve NPF patients who underwent craniotomy with endoscopic assistance from March 2002 to July 2008 at the Beijing Tongren Hospital were selected. All patients were male. Their ages ranged from 11 to 33 years. The main symptoms were visual deterioration, exophthalmos, nasal obstruction, epistaxis and pharynx nasalis neoplasm. The diagnosis was based on CT, MRI and digital subtraction angiography (DSA). All patients had intracranial encroachment and all underwent DSA and embolism treatment were taken before surgery. Seven patients had a pterional craniotomy, five had a frontal-temporal-orbital-zygomatic craniotomy. Most of the tumor was resected piecemeal, then removed through the sphenoidal sinus. Finally, using an endoscope in the nasal cavity, tumor in nasal cavity was resected and removed through the sphenoidal sinus, observing the dead angle of the craniotomy and confirming that sinus drainage was unobstructed.

RESULTSThe tumor was removed completely in 11 patients and partially resected in one patient because of hemorrhage. One patient had an infection after the operation and one patient had cerebrospinal rhinorrhea 3 years after surgery that was remediated by endoscopic repair.

CONCLUSIONCraniotomy with endoscopic assistance in the treatment of NPF was minimally invasive, safe and efficient, and avoided facial incision.

Adolescent ; Adult ; Child ; Child, Preschool ; Craniotomy ; adverse effects ; methods ; Endoscopy ; adverse effects ; methods ; Fibroma ; diagnostic imaging ; pathology ; surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Nasopharyngeal Neoplasms ; diagnostic imaging ; pathology ; surgery ; Radiography ; Young Adult

BACKGROUND AND OBJECTIVEThe level-Ib lymph node metastasis is rare in nasopharyngeal carcinoma (NPC). When and how this level should be irradiated with precise radiotherapy remains controversial. This study evaluated the prevalence and prognostic significance of level-Ib lymphadenopathy on the prognosis of NPC patients.

METHODSFrom January 1990 and December 1999, 933 newly diagnosed patients with NPC treated at Sun Yat-sen University Cancer Center were randomly selected, examined with computed tomography (CT) imagining for evidence of level-Ib lymphadenopathy before treatment. All patients received radical radiotherapy with or without chemotherapy. The relationship between level-Ib lymphadenopathy and post-treatment outcomes including overall survival (OS), locoregional recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were analyzed using Kaplan-Meier methods. The Cox proportional hazards regression model was used to adjust for other prognostic factors.

RESULTSOf the 933 patients, 55 (5.9%) were found to have level-Ib lymphadenopathy, which was associated with carotid sheath involvement, oropharynx involvement and levels, and lateral cervical lymph node involvement. In the subgroup with carotid sheath involvement, with multivariate analysis accounting for all previously known prognostic factors, level-Ib lymphadenopathy was still associated with a risk of decreased OS (RR, 2.124; P<0.001), DMFS (RR, 2.168; P<0.001), and LRFS (RR, 1.989; P=0.001).

CONCLUSIONLevel-Ib lymphadenopathy in the patients with carotid sheath involvement is an independent prognostic factor.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; diagnostic imaging ; drug therapy ; pathology ; radiotherapy ; Chemotherapy, Adjuvant ; Child ; Cobalt Radioisotopes ; therapeutic use ; Female ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; diagnostic imaging ; drug therapy ; pathology ; radiotherapy ; Neck ; pathology ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Particle Accelerators ; Pharynx ; pathology ; Prognosis ; Proportional Hazards Models ; Radiography ; Radioisotope Teletherapy ; Retrospective Studies ; Survival Rate ; Young Adult