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Published on: July 5, 2021
Recurrence of a nasopharyngeal carcinoma manifesting as a cerebellopontine angle mass
Min Han Kong1, Jahendran Jeevanan, Thanabalan Jegan
1Department of Otorhinolaryngology-Head and Neck Surgery, Pantai Cheras Medical Centre, 1 Jalan 1/96a, 56100 Cheras, Kuala Lumpur, Malaysia.
Abstract:
As many as 31% of patients with nasopharyngeal carcinoma present with intracranial extension. Despite this high percentage, extension to the cerebellopontine angle is rare. The mechanism of tumor spread to the cerebellopontine angle is not completely understood. The most likely mechanism is direct extension to the skull base with involvement of the petrous apex and further extension posteriorly via the medial tentorial edge. We report the case of a 46-year-old woman with nasopharyngeal carcinoma who had been treated initially with chemoradiation and subsequently with stereotactic radiosurgery for residual tumor. One year later, she presented with an intracranial recurrence of the nasopharyngeal carcinoma in the cerebellopontine angle; the recurrence mimicked a benign tumor on magnetic resonance imaging. The tumor was ultimately diagnosed as an undifferentiated carcinoma of nasopharyngeal origin. She was treated with palliative chemotherapy.
Insights
Nasopharyngeal carcinoma can extend into the brain, but rarely to the cerebellopontine angle. This case highlights a rare recurrence mimicking a benign tumor, emphasizing the need for vigilance in nasopharyngeal carcinoma patients.
Area of Science:
- Neuro-oncology
- Skull base surgery
- Radiation oncology
Background:
- Nasopharyngeal carcinoma (NPC) frequently presents with intracranial extension (31%).
- Extension to the cerebellopontine angle (CPA) is an uncommon but serious complication.
- Understanding the precise mechanisms of CPA spread in NPC is crucial for diagnosis and treatment.
Observation:
- A 46-year-old woman with NPC, treated with chemoradiation and stereotactic radiosurgery, developed a CPA recurrence.
- The recurrent tumor on magnetic resonance imaging (MRI) mimicked a benign lesion.
- Histopathological diagnosis confirmed undifferentiated carcinoma of nasopharyngeal origin.
Findings:
- The case illustrates a rare intracranial recurrence of NPC in the CPA one year after initial treatment.
- The recurrence presented insidiously, resembling a benign tumor on imaging, complicating early detection.
- Direct extension through the skull base, particularly the petrous apex and medial tentorial edge, is the presumed pathway.
Implications:
- This case underscores the importance of considering NPC recurrence in the CPA, even with atypical imaging findings.
- It highlights the challenges in differentiating NPC recurrence from other CPA masses.
- Palliative chemotherapy was administered for the recurrent disease, indicating limited therapeutic options for advanced or recurrent intracranial NPC.
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