[A case with nasopharyngeal carcinoma extending into the cavernous sinus]

Nasopharyngeal carcinoma is seen frequently in South China, but it is rare in Japan as well as in Western countries. We reported a rare case with intracranial extension at the initial presentation. This 25-year-old Japanese female showed left abducens palsy. MRI revealed an intracavernous mass with homogeneous enhancement connected with the lesion around the epipharynx through the parapharyngeal space. The mass enlarged gradually, followed by left trigeminal palsy. An elevation of the titer of serum EBV Ig-G was noted. She was operated on via the subtemporal approach, which revealed an intracavernous tumor, connected with the infratemporal fossa mass via the enlarged foramen ovale. Histological examination of the surgical specimen revealed lymphoepithelioma. Local irradiation of 60Co of 63 Gy was performed on the cavernous and parapharyngeal tumors and they decreased in size remarkably. However, metastasis to the upper right neck lymph node occurred, and it was removed. Additional irradiation of 45 Gy was performed on her neck. Chemotherapy was not able to be carried out due to leucocytopenia. At present, 2 years after onset, no regrowth of the tumor has been seen. At initial presentation, intracranial extension of nasopharyngeal carcinoma is very rare. Remission may be obtained by a combination of surgery and irradiation even in cases with metastasis.