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This case report details a 47-year-old male with a rare diagnosis of nasopharyngeal mucoepidermoid carcinoma, discussing presentation, diagnostic process, treatment, and outcomes. Surgical treatment challenges and survival rates are highlighted.
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台灣耳鼻喉科醫學會105屆 Nasopharyngeal Mucoepidermoid Carcinoma - A Common Entity at an Uncommon Location Reporter: R4 何承宇 Supervisor : VS 林虞軒
Case general profiled • Name:吳XX • Age: 47 years old • Gender: Male • Date of OPDvisited : 2017/09/20 • Past history : denied
Chief Complaint • Double vision while looking at right side was found at 9/17 morning.
Present Illness (1) • Dizziness without spinning sensation ; no postural-related • No headache or other neurological sign, such as weakness, hearing loss, ear fullness, extremities numbness, facial asymmetry, neck stiffness, photophobia or phonophobia • Associated symptoms/signs: • Weakness(-) • Hearing loss(-) • Ear fullness (-) • Limbs weakness(-) • Facial palsy(-)
Brain MRI T1 with contrast • A 1.8cm enhancing lesion in right nasopharynx.
Consult ENT • One polypoid lesion was noted at right rosenmuller fossa
Arrange Biopsy • (2017-09-22) PATHOLOGICAL DIAGNOSIS: Nasopharynx, biopsy: Lymphoid hyperplasia with a cluster of atypical cells • (2017-10-03) PATHOLOGICAL DIAGNOSIS: Nasopharynx, biopsy: Granulation tissue with fibrin deposition and suppurative inflammation
Admission for open diopsy • Admission to our ward for deep biopsy (2018-04-18) • Frozen : Nasopharynx, right, Rossenmuller fossa, biopsy: Mucoepidermoid carcinoma
Final pathology • PATHOLOGICAL DIAGNOSIS: 1.Nasopharynx, right, debulking surgery: Mucoepidermoid carcinoma, low-grade. 2.Nasopharynx, labeled "deep margin", right, debulking surgery: Mucoepidermoid carcinoma, by invasion. Tumor cells are positive for CK7 and p63, but negative for S100 and EBER in situ hybridization.
Mucoepidermoid carcinoma, low-grade • Higher proportion of mucous cells to epidermoid cells.
Tumor staging • MRI: Tumor (1.8cm) cT1N0 • Neck echo: N0 • Abdominal echo / Chest X-ray / Bone scan : M0 cT1N0M0
Treatment • Discussion with patient. At first do operation first • However, severe complication was considered • refer to radiooncologist • Finally, do RT ( Since 2018/6/4) • Finish RT on 2018/8/7
Post Treatment follow up • 10/01 Fiberscopy exam: right nasopharynx: grossly smooth, mild necrotic tissue
Discussion • To date, there are only 44 adult patients with nasopharyngeal MEC from 9 English-language studies in the literature. • No gender preponderance (NPC: 3-fold higher in males compared with females. ) • More Local symptoms ( ear stuffness / Nasal obstruction) • Less regional (16.7%) or distant metastasis (8.6%) • Larger proportion of nasopharyngeal MEC patients present with early stage disease (57.1%), although histologically most tumors (61.8%) are intermediate or high-grade tumors
Discussion-surgical treatment • Surgical treatment is the gold standard for MEC, and the challenge is the anotomy. (Skull base , ICA) • lateral rhinotomy • transmaxillary swing • transoral-palatal • lateral infratemporal fossa • subfrontal routes • Endoscopic approach
Discussion-outcome • Data on survival rate for nasopharyngeal MEC is limited due to the small numbers of patients in the studies. • The largest patient series of 13 patients reported an overall median survival of 43 months.
