64 years old mal with sinusitis and middle ear effusion and mastoidit

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Doctor's Information

Name : Hamidreza
Family : Haghighatkhah
Affiliation :Radiology Department,Shohada Tajrish Hospital,SBMU
Academic Degree : Associate Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Abolfazl amin poor

Case Section

Head & Neck Imaging

Patient's Information

Gender : Male
Age : 64

Clinical Summary

64 years old mal with sinusitis and middle ear effusion and mastoiditis

Imaging Findings

A soft tissue mass is seen centered on and obliterating the left fossa of Rosenmuller. The mass extends anteriorly into the posterior nares, superiorly invades the clivus and laterally invades the pterygoids. The mass is hypointense in T1, iso intense in T2 and enhances intensely after contrast.An enhancing mucosal/submucosal infiltrative mass is causing asymmetrical narrowing of the oropharynx. Note left mastoid effusion secondary to Eustachian tube blockage! few small L.N with enhanced spascialy in left side was seen.

Differential Diagnosis

nasopharyngeal lymphoma metastases chordoma chondrosarcoma meningioma even pituitary macroadenoma Adenoid cystic carcinoma of nasopharynx

Final Diagnosis

Poorly differentiated squamous cell carcinoma.

Discussion (Related Text)

Nasopharyngeal carcinomas are divided into three types : type I - keratinizing squamous cell carcinoma type II - non-keratinizing squamous cell carcinoma (aka lymphoepithelioma) type III - undifferentiated carcinoma All three types express cytokeratin, and types II and III have incorporation of the EBV into their genome, and circulating IgA antibodies to EBV in peripheral blood CT is not only more readily available but is also the ideal modality to assess early bony involvement. Nasopharyngeal carcinomas appear as soft tissue masses most commonly centred at the lateral nasopharyngeal recess (fossa of Rosenmüller).MRI is more sensitive to perineural spread and for demonstrating early the bone marrow changes of infiltration (see normal bone marrow signal of the clivus), although not all bone marrow changes represent tumour extension . Similarly dural thickening may be both evidence of tumour infiltration or reactive hyperplasia . T1 - typically isointense to muscle T2 -isointense to somewhat hyperintense to muscle fat saturation is helpful 5 fluid in the middle ear is a helpful marker T1 C+ (Gd) - post contrast sequences should be fat saturated prominent heterogeneous enhancement is typical perineural extension should be sought