PEDIATRIC NASOPHARYNGEAL CARCINOMA
* Clerkship of Medical Faculty University of islamic Malang
Nasopharyngeal carcinoma (NPC) is the most commonly diagnosed head and neck malignancy in China and Southeast Asian countries. NPC rarely occurs in children and adolescent.2 NPC is caused by
the genetic changes, environmental factors (e.g., exposure to chemical carcinogens), and infection of Epstein-Barr virus.7 The incidence among children and adolescents varies greatly, accounts for 0.1-
2.3% of all NPCs in China and 2%-18% in other countries.2
Case Description
Nasopharyngeal carcinoma is one of the tumors
originating from the epithelium observed in children,
distinguished from adults associated with Epstein-Barr
virus (EBV) infection, with undifferentiated histology. It
rarely appears in children under 14 years. Another
study said that NPC in pediatrics of 1-5% and 20-50% of
primary malignant nasopharyngeal tumors in
children.1,3
The pathogenesis of NPC is related to genetic and
environmental factors. HLA antigen subtypes,
chromosome deletions that affect tumor suppressor
genes. Infection with Epstein-Barr virus is a factor
commonly associated with pathogenesis of type II and
III your
Add NPC. Additional
information, environmental
graphs and images to this section. risk factors including
smoking and preserved food, formaldehyde, and wood
dust.1,4,6
The extent of the disease is determined by clinical
examination using nasopharyngoscopy, Computed
Tomography (CT) - head and neck, MRI, anatomic
pathology examination, chest radiography, abdominal
ultrasound and bone scanning. Tumor stages are
classified according to the 8th editions of UICC/AJCC.5,7
The prognosis has improved with advances in
radiotherapy and the use of neoadjuvant or adjuvant
chemotherapy.1
A 12th years old boy with frequent breath
shortness since approximately 3 years ago and worsen
since a week ago. The patient also complaint of nasal
congestion that makes sound like a nasal voice. The
furthermore, also complaint of headache and seizure
but is rarely and then comes to the radiology
department and undergoes MSCT examination without
contrast.
Nadia Rahmayanti*, Tigor Yeheskiel**
** Radiologist of Blambangan Hospital
Background
Discussion
Nasopharyngeal carcinoma (NPC) is a rare malignant tumor derived from the
epithelium lining the nasopharynx.6 NPC was determined by clinical examination using
rigid or flexible nasopharyngoscopy, CT-scan, chest radiography, USG. CT scan will show
a hypodens lesion. In this case A 12th years old boy with frequent breath shortness
since approximately 3 years ago and worsen since a week ago. The patient also
complaint of nasal congestion that makes sound like a nasal voice. The furthermore,
also complaint of headache and seizure but is rarely. The results CT scan without
contrast of the head on axial and sagittal pieces show thickening of the right and left of
nasopharynx which agglomerates the rosenmuller fossa and torus tubarius. MRI with
contrast of the head on axial pieces shows signal hyperintensity in the right sphenoid
sinus, the right ethmoidalis, the right and left of mastoid air cells (prominent right) and
inferior concha hypertrophy. On the nasopharynx, lobulated (2.4 x 3.4 x 2.5 cm) lesions
form a regular border on the right and left of symmetrical nasopharynx that extends to
the oropharynx with signal intensity isointens at T1W1, slightly hyperintense at T2W1,
FatSat. Post contrast injection appears enhancement. The obliteration on the left and
right of torus tubarius. Based on the clinical manifestation and the examination, this
patient was diagnosed with Pediatric Nasopharyngeal Carcinoma. NPC TNM Staging,
nasopharyngeal carcinoma with a slight extension of the tumor to the oropharynx (T1),
no lymph node metastases (N0), no distant metastases (M0) and constitute a Stage 1
(T1 N0 M0).7 The chest radiography was not found abnormalities.
NPC related to environmental risk factors including smoking and preserved food,
formaldehyde, and wood dust.6
Conclusion
Nasopharyngeal carcinoma (NPC) is the most commonly diagnosed head and neck malignancy. Nasopharyngeal carcinoma (NPC) determined by
clinical examination using nasopharyngoscopy, Computed Tomography (CT) - head and neck, MRI and anatomic pathology examination. The
prognosis has improved with advances in radiotherapy and the use of neoadjuvant or adjuvant chemotherapy.
Reference
1. Alejandro González-Motta, González G, Bermudéz Y,
et al. 2016. Pediatric Nasopharyngeal Cancer: Case
Report and Review of the Literature. Cureus 8(2):
e497. DOI: 10.7759/cureus.497
2. Weixin Liu, Yuan Tang, Li Gao, et al. 2014.
Nasopharyngeal carcinoma in children and
adolescents - a single institution experience of 158
patients. 9:274.
3. Chua MLK, Wee JTS, Hui EP, Chan ATC.
Nasopharyngeal Carcinoma. Lancet, 2015: doi:
10.1016/S0140-6736(15)00055-0
4. Young, L. S. dan Christopher W. Dawson. 2014.
Epstein-Barr Virus and Nasopharyngeal Carcinoma.
Chin J Cancer. 33(12): 581-590
5. Adham M, Stoker SD, Wildeman MA, Rachmadi L,
Gondhowiardjo S, et al. (2014) Current Status of
Cancer Care for Young Patients with Nasopharyngeal
Carcinoma in Jakarta, Indonesia. PLoS ONE 9(7):
e102353. doi:10.1371/journal.pone.0102353
6. Morgan K. Richards, et al. 2016. Factors Associated
With Mortality in Pediatric vs Adult Nasopharyngeal
Carcinoma. JAMA Otolaryngol Head Neck Surg.
2016;142(3):217-222. doi:10.1001/jamaoto.2015.321
7. Ling-Long Tang, Yu-Pei Chen, Yan-Ping Mao, et.al.
2017. Validation of the 8th Edition of the UICC/AJCC
Staging System for Nasopharyngeal Carcinoma From
Endemic Areas in the Intensity-Modulated
Radiotherapy Era. J Natl Compr Canc Netw
2017;15(7):913–919. Doi:10.6004/jnccn.2017.0121