Secondary primary tumor mimicking osteoradionecrosis

Area of Science:

• Oncology
• Radiotherapy
• Head and Neck Cancer

Background:

• Nasopharyngeal carcinoma (NPC) is a rare malignancy (1% of all cancers).
• Standard NPC treatment involves radiotherapy, often with chemotherapy.
• Radiotherapy can cause long-term complications like second primary tumors (SPTs) and osteoradionecrosis (ORN).

Purpose of the Study:

• To describe a challenging case of distinguishing between SPT and ORN.
• To emphasize the importance of considering SPT in long-term radiotherapy follow-up.
• To highlight diagnostic difficulties due to similar radiological features.

Main Methods:

• Case report presentation.
• Review of patient history including 20-year post-radiotherapy follow-up.
• Radiological assessment and differential diagnosis discussion.

Main Results:

• A patient developed a lesion in a previously irradiated area with a history of tooth extraction.
• The lesion's radiological characteristics mimicked osteoradionecrosis (ORN).
• The final diagnosis, confirmed over time, was a second primary tumor (SPT).

Conclusions:

• Distinguishing between SPT and ORN after long-term radiotherapy can be diagnostically challenging.
• SPTs can arise in previously irradiated head and neck sites, even years after treatment.
• Vigilance and consideration of SPT are crucial in patients with a history of NPC radiotherapy presenting with suspicious lesions.