presentation1.pptx, radiological imaging of the nasopharyngeal diseases
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Dr/ ABD ALLAH NAZEER. MD.
Radiological imaging of the nasopharyngeal diseases.
Adenoids
Nasopharyngeal abscess (MRI scan, sagittal view). Nasopharyngeal abscess (MRI scan, axial view).
Latero and Retropharyngeal abscess (CT scan, axial view). B. Latero and Retropharyngeal abscess (CT scan, sagittal view). C. Lateropharyngeal abscess (CT scan, coronal view). D. Lateropharyngeal abscess (CT scan, axial view).
Inflammatory pseudotumor of the nasopharynx and skull base is a benign, idiopathic disease that is often mistaken for a neoplasm or infection owing to its aggressive behavior and clinical presentation. It can present as a progressively destructive mass and should be considered when repeated tissue biopsies reveal acute or chronic inflammation without evidence of malignant disease or infection. Nasopharyngeal inflammatory pseudotumor with skull base invasion occurring in patients with diabetes mellitus (DM). These patients had repeated negative results from biopsies and cultures, and none had associated cervical lymphadenopathy despite having an aggressive destructive mass. We suggest that these findings, coupled with clinical suspicion, will be helpful in making the correct diagnosis of inflammatory pseudotumor. This is critical in the management of these patients to institute the correct treatment plan.
A 32-year-old man with right ptosis, trigeminal neuralgia and facial palsy 2 days after an episode of acute otitis media treated with tympanocentesis. (a) Axial T1 weighted image shows an intermediate signal intensity mass lesion involving the right nasopharyngeal submucosal region (arrows). (b) Axial T2 weighted image shows low signal intensity change of the lesion (arrows). Note the right mastoiditis change. (c) Coronal contrast-enhanced T1 weighted image shows extension of the lesion to the right skull base, cavernous sinus and Meckel’s cave (black arrows). Enhancement of the thickened pachymeninges is also present (white arrows). (d) Axial T2 weighted and (e) contrast-enhanced images obtained 2 months after a course of intravenous high-dose pulse solumedrol therapy followed by oral corticosteroid medication show the mass lesion to be significantly reduced in size. The pachymeningeal enhancement has nearly disappeared
A 32-year-old man with left hemicrania of 5 months’ duration and hemitongue atrophy of 1 months’ duration. (a) Axial T1 weighted image and (b) axial T2 weighted image show an ill-defined hypointense lesion in the left nasopharyngeal submucosal region with extension to the carotid space and skull base. The left internal carotid artery is encased and narrowed(white arrow). Involvement of the hypoglossal canal (black arrow) is evident. The mass lesion is distinguishable from the nasopharyngeal mucosa on T2 weighted images. (c) Axial contrast-enhanced T1 weighted image with fat saturation shows moderate enhancement of the left nasopharyngeal lesion, with extension around the left internal carotid artery into the skullbase, and involving the prevertebral muscles and hypoglossal canal (black arrow). (d) Axial T2 weighted and (e) contrast enhanced T1 weighted image obtained 2 months after a course of oral corticosteroids show nearly complete resolution of the mass lesion.
A 37-year-old man with right hemicrania of 2 months’ duration. (a) Axial T2 weighted image shows hypointensity and (b) axial contrast-enhanced T1 weighted image shows moderate enhancement of the lesion in the right nasopharyngeal submucosa and carotid space (white arrows), which encases the right internal carotid artery with extension to the skull base. There is high signal change on T2 weighted images and abnormal contrast enhancement in the bone marrow of the right occipital condyle (black arrows). (c) Contrast-enhanced MR angiography shows segmental narrowing of the right upper cervical internal carotid artery (white arrows) owing to the encasement by the carotid space lesion.
Thornwaldt cyst.
Thornwaldt cyst
Juvenile nasopharyngeal angiofibroma.
Juvenile nasopharyngeal angiofibroma.
Neonatal teratomas are very rare congenital tumors which are formed from cells derived from all three embryonic germ cell layers. The incidence of neonatal teratomas is between 1:20,000 and 1:80,000 live births. Most occur in the sacrococcygeal region and only 5% are found in the head and neck region, specifically the cervical region followed by the nasopharynx. They can be associated with a cleft palate, intracranial abnormalities including hemicrania and anencephaly, other head and neck anomalies, diaphragmatic hernia and renal and vertebral anomalies.Nasopharyngeal teratomas most commonly present with difficulties in swallowing and obstructive respiratory distress. The size and location serve as the major causes of morbidity and mortality. Rapid airway stabilization, including endotracheal intubation, cricothyrotomy or tracheotomy, is crucial in the management of these patients. After securing the airway, imaging is very useful to help differentiate this tumor from other masses. Ultimately surgical excision is the mode of treatment. These tumors are often encapsulated or pseudoencapsulated which yields excellent surgical prognosis. The differential diagnosis for neonatal nasopharyngeal lesions is extensive and includes: teratoma, dermoid, craniopharyngioma, encephalocele, cystic hygroma, rhabdomyoscarcoma, hemangioma, lipoma, chordoma, neurofibroma, Rathke’s pouch and sarcoma botryoides.
Nasopharyngeal teratoma.
Nasopharyngeal teratoma.
(a) T2 weighted sequence in coronal plane showing the external portion of the tumour consisting of lobulated well defined areas of fluid, solid tissue and fat, in keeping with teratoma. There is involvement of the left temporal lobe of the brain (red arrow); (b) T1 weighted contrast enhanced sequence in sagittal plane. Internally, the tumour is occupying the oropharynx, nasopharynx and oral cavity, effacing normal anatomy (red arrows).
Nasopharyngeal hemangioma.
Chordoma is a low-grade malignant tumor that arises from the remnants of notochord. They account for 1-4% of malignant bone tumors and most commonly present after the age of 30 years. Male to female ratio is 1.8:1. Majority occur in sacrum or in the clivus (a bony surface in the posterior cranial fossa sloping upward from foramen magnum to dorsum sella). Those located in the clivus are often associated with a chronic headache and symptoms due to compression of a cranial nerve. Lateral extension can lead to a cerebellopontine angle tumor symptomatology. In case of inferior spread, nasal obstruction, bleeding, and even nasal mass appear.
Chordoma.
Two cases of cystic choristoma along the nasopharynx and the prestyloid spaces.
Paraganglioma of the nasopharynx.
Naso and parapharyngeal para-ganglioma.
Nasopharynx cancer or nasopharyngeal carcinoma (NPC) is the most common cancer originating in the nasopharynx, the uppermost region of the pharynx ("throat"), behind the nose where the nasal passages and auditory tubes join the remainder of the upper respiratory tract. NPC occurs in children and adults. NPC differs significantly from other cancers of the head and neck in its occurrence, causes, clinical behavior, and treatment. It is vastly more common in certain regions of East Asia and Africa than elsewhere, with viral, dietary and genetic factors implicated in its causation. It is most common in males. It is a squamous cell carcinoma or an undifferentiated type. Squamous cells are a flat type of cell found in the skin and the membranes that line some body cavities. Differentiation means how different the cancer cells are from normal cells. Undifferentiated is a word used to describe cells that do not have their mature features or functions.
Classification:Nasopharyngeal carcinoma, commonly known as nasopharyngeal cancer, is classified as a malignant neoplasm, or cancer, arising from the mucosal epithelium of the nasopharynx, most often within the lateral nasopharyngeal recess or fossa of Rosenmüller (a recess behind the entrance of the Eustachian tube opening). The World Health Organization classifies nasopharyngeal carcinoma in three types. Type 1 (I) is squamous cell carcinoma. Type 2a (II) is keratinizing undifferentiated carcinoma. Type 2b (III) is nonkeratinizing undifferentiated carcinoma. Type 2b (III) nonkeratinizing undifferentiated form also known as lymphoepithelioma is most common, and is most strongly associated with Epstein-Barr virus infection of the cancerous cells.
Axial T2 weighted images shows a carcinoma that has infiltrated lateral to the tensor and levator veli palatini. Solid arrow shows normal tensor veli palatini on the right. Dashed arrow shows the abnormal left levator muscle which is being displaced and the presence of tumor lateral to it.
Sagittal T1 image that shows NPC invasion into the clivus. There is a loss ofthe inferior cortical margin of the clivus. The clivus is also of uniform lower signal that reflects sclerotic change. 10B is as coronal T1 image in another patient that shows NPC infiltration into the left aspect of the clivus (arrow).
Coronal T2 (left) and post gadolinium enhanced T1 (right) weighted images showsuperior extension of NPC through the floor of the sphenoid sinus (arrows).
Two cases of nasopharyngeal tumour, extended laterally into the left masticator space and subsequent perineural tumor tracking superiorly along V3 into the left cavernous sinus.
Carcinoma of the nasopharynx. Coronal T1 weighted, fat suppressed, contrast enhanced MR image shows an enhancing lesion(T) in the nasopharynx with extension into bilateral cavernous sinuses(white arrows) via foramen ovale (black arrows). Both cavernous internal carotid arteries are encased by the lesion. There is also extension into left infratemporal fossa(small open black arrow).
A case of locally advanced nasopharyngeal carcinoma in a 44-year-old man with right-ear tinnitus and hearing impairment of 1 year’s duration. (a)AxialT1weighted image shows a bulging right nasopharyngeal mass with extension to the skull base, partially encasing the right internal carotid artery. The right parapharyngeal fat is obliterated. (b) Axial T2 weighted image shows mild hyperintensity of the right nasopharyngeal mass. The signal intensity of the mass is similar to that of the nasopharyngeal mucosa, and the margin between the normal mucosa and the mass could not be delineated. Note the presence of right mastoiditis change. (c) Axial and (d) coronal contrast enhanced T1 weighted images with fat saturation shows vivid enhancement of the nasopharyngeal mass. There is skull-base and cavernous sinus invasion with encasement of the right internal carotid artery, which is not narrowed (white arrows). Bilateral neck lymphadenopathy (black arrows) is prominent.
Nasopharyngeal non-Hodgkin lymphoma.
Granulocytic sarcoma in the right lateral wall of the nasopharynx (black arrow), involving the right pterygoid muscles, parapharyngeal space Figure 1b: CT sagittal image shows mass in the nasopharynx with extension into sphenoid sinus Figure 1c: CT coronal image shows that the mass is confined to the nasopharynx without intracranial extension.
Leiomyosarcoma in the Nasopharynx:
Thank You.