Nasopharyngeal carcinoma during pregnancy

Nasopharyngeal carcinoma, particularly during pregnancy, rarely comes to medical attention before it spreads to the regional lymph nodes.

We report a 26-year-old Taiwanese woman who suffered from persistent headache and purulent nasal discharge during mid-pregnancy. Magnetic resonance imaging examination showed a large soft tissue mass measuring 3 x 2 x 2 cm in the left nasopharynx at 31 weeks of gestation. Punch biopsy of the tumor was done, and the histopathologic report revealed poorly differentiated, non-keratinizing type of squamous cell carcinoma (T4N2M0). A female infant weighing 1,790 g was delivered by cesarean section at 33 weeks of gestation with Apgar scores of 5 and 8 at 1 and 5 minutes, respectively. The patient received chemotherapy and radiation therapy after delivery. She was disease-free for 3 years. Subsequently, the patient delivered a second healthy infant weighing 3,084 g in a consecutive pregnancy, with a 3-year birth interval. Her first and second child showed normal psychomotor development at 3 years and 6 months of age, respectively.

The possibility of rare nasopharyngeal carcinoma should be considered in any pregnant woman with presenting symptoms of persistent headache and abnormal nasal discharge, and a detailed thorough investigation is indicated. Successful pregnancy outcome can be achieved after tailored use of a combination of chemotherapy and radiotherapy.