Nasopharyngeal carcinoma presenting as muscular atrophy – A
Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...
Nasopharyngeal carcinoma (NPC) is a unique malignancy that arises from the epithelium of the nasopharynx and has a restricted prevalence in certain regions of the world. Nasopharyngeal Carcinoma seems to occur due to a multi-factorial process as well as investable corollary in which it involved the contributions of Epstein Barr Virus (EBV), ethnic background, and environmental carcinogens.

Case notes
A 40-year-old male patient reported to the department of Oral Medicine and Radiology with a chief complaint of progressive sunken appearance of the right side of the face especially in the temple and cheek region for 4 months. History also revealed mild pain with difficulty on chewing from the right side of the face and intra-oral mild persistent pain which was non-radiating in nature . No contributing medical history or habit history was elicited.

On clinical examination , the right temporalis muscle appeared to be atrophied with outlines of the underlying bone clearly visible. The right masseter muscle did not appear to be grossly atrophic but presented with a sunken appearance. On palpation the area was non-tender.

The patient was subjected to a panoramic radiographic view which revealed grossly carious 18, 28, 36, and 46 with periapical radiolucency with 36 and 46. Horizontal impactions were present with 38 and 48. Slightly enlarged mandibular canal was visible bilaterally.

The patient was sent to the general radiology department for further investigations after taking written informed consent for advanced investigations in which NCCT (Non-Contrast Computed Tomography) face was done which revealed a large soft tissue mass in the right nasopharyngeal region. CECT (Contrast Enhanced Computed Tomography) face was done which revealed a large hypodense lesion in the right nasopharyngeal region obliterating the fossa of rosenmuller extending inferiorly involving the anterior tonsillar pillar.

Superiorly, it was invading the base of skull with involvement of various skull foramina and extending further superiorly up to the right cavernous sinus and middle cranial fossa through right foramen ovale causing its widening suggestive of perineural extension. Laterally the mass was invading the right parapharyngeal space and medially bulging into the nasopharyngeal airway. Posteriorly, it was invading in the retropharyngeal space. There was evidence of denervation atrophy of right sided muscles of mastication including masseter, temporalis, medial, and lateral pterygoid muscles. There was evidence of heterogeneous enhancement of the soft tissue mass and presence of enlarged lymph nodes level I and level II.

The patient was subjected to biopsy through endoscopy and the histopathological investigation revealed the presence of squamous epithelial cells arranged in the form of small islands within the connective tissue. The lesional epithelial cell showed close resemblance to the cell of origin along with numerous keratin pearl formations, the section also revealed varying degrees of cellular and nuclear pleomorphism, individual cell keratinization, mitotic figures, increase in the number of nucleoli, and keratin pearl formation. A final diagnosis of Nasopharyngeal carcinoma was made on radiological and histopathological basis

Nonetheless, this case highlights the importance of considering NPC as one of the causes of muscular atrophy with mild pain. The clinician should always be alert to the possibility of infiltrative tumor and the role of an oral physician and maxillofacial radiologist in diagnosing this rare disease is emphasized through this report.

1 share