PMC6414426_01
T1 post-contrast fat saturated MRI images (top row) demonstrates diffuse enhancement of the large aggressive mass in the posterior left nasal cavity and nasopharynx (star) invading the left maxillary sinus, nasal septum, left pterygopalatine fossa, left masticator and pharyngeal spaces, and left longus colli muscle causing narrowing of the nasal airway and nasopharynx along with cervical lymphadenopathy (yellow arrows). Fused PET/CT images (bottom row) demonstrate a large FDG avid mass in the left nasal cavity with extension to the maxillary sinus and nasopharynx. There is also an enlarged FDG avid left level 2 cervical lymph node (red arrow).
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F1
MRI with and without gadolinium contrast performed on a 3-T Siemens Skyra showed a large mass in the posterior left nasal cavity and nasopharynx invading the left maxillary sinus, nasal septum, left pterygopalatine fossa, left masticator and pharyngeal spaces and left longus colli muscle causing narrowing of the nasal airway and nasopharynx as well as a unilateral mastoid effusion (Figure 1, top row). Time of Flight system imaged from the top of the skull to the feet (FDG dose 6.8 mCi). The scan demonstrated an intense FDG avid mass in the left nasopharynx and nasal cavity extending to the left maxillary sinus (SUV max 10.8) and a metastatic left cervical lymph node (SUV max 6.9) with no distant metastasis (Figure 1, bottom row).
Biopsy of nasopharyngeal carcinoma. (A, 4x magnification) Large epithelioid cells divided by sheets of small dark lympho-plasmacytic cells demonstrating the biphasic nature of the tumor. (B, 20x magnification) Large pleomorphic nuclei with open chromatin and prominent nucleoli within the epithelioid component and both plasmacytic and lymphocytic differentiation within the lymphoid component. (C, 20x magnification) Positive staining (violet) within the nuclei of the large epithelioid cells and negative staining (pink) of the lympho-plasmacytic cells indicating the presence of Epstein-Barr Virus RNA expression in the epithelioid component. (D, 20x magnification) positive CK-5/6 immunohistochemical staining (brown) in a membranous distribution on the epithelioid cells with negative staining (blue) on the lympho-plasmacytic cells.
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F2
Subsequent biopsy of the mass was consistent with non-keratinizing nasopharyngeal carcinoma (Figure 2).