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Published on: January 5, 2017
Skull Base Aspergillus Infection Mimicking Tumor Recurrence: A Nasopharyngeal Carcinoma Case Study
Abstract:
We report a case of recurrent nasopharyngeal carcinoma postnasopharyngectomy, presenting with headaches. MRI revealed abnormal signals of the clivus with enhancement, and FDG PET/CT indicated intense uptake in the nasopharynx, clivus, and left neck lymph nodes. Bone SPECT/CT showed bony erosion and uptake in bilateral skull base areas. Biopsy confirmed aspergillosis. Despite the challenges in distinguishing tumor invasion from Aspergillus infection on MRI, bone SPECT/CT, and FDG PET/CT, the short postsurgery period and extensive uptake suggested skull base osteomyelitis.
Insights
Recurrent nasopharyngeal carcinoma can mimic Aspergillus infection. Imaging findings like MRI, PET/CT, and SPECT/CT can be challenging to interpret, suggesting skull base osteomyelitis.
Area of Science:
- Oncology
- Infectious Diseases
- Radiology
Background:
- Recurrent nasopharyngeal carcinoma (NPC) presents a diagnostic challenge, especially when symptoms overlap with infections.
- Distinguishing tumor recurrence from opportunistic infections like aspergillosis post-surgery requires careful evaluation of imaging and clinical data.
Observation:
- A patient with a history of nasopharyngeal carcinoma post-surgery presented with headaches.
- MRI showed abnormal clival signals, FDG PET/CT revealed intense uptake in the nasopharynx, clivus, and neck lymph nodes.
- Bone SPECT/CT indicated bony erosion and uptake in the skull base.
Findings:
- Biopsy confirmed Aspergillus infection.
- Despite challenging imaging interpretation, the clinical context (short postsurgery period) and imaging patterns suggested skull base osteomyelitis over tumor recurrence.
Implications:
- This case highlights the difficulty in differentiating tumor invasion from Aspergillus infection using standard imaging modalities.
- Skull base osteomyelitis should be considered in the differential diagnosis of post-surgical NPC patients presenting with similar symptoms and imaging findings.
- Multimodality imaging and biopsy are crucial for accurate diagnosis and appropriate management.
