NASOPHARYNGEAL CARCINOMA IN AN ADOLESCENT AFRICAN AMERICAN MAN PRESENTING AS TEMPOROMANDIBULAR JOINT DISORDER: A CASE REPORT WITH MULTIDETECTOR COMPUTED TOMOGRAPHY AND MAGNETIC RESONANCE IMAGING

Abstract

<h3>BACKGROUND</h3> Nasopharyngeal carcinoma (NPC) has unique demographic characteristics, risk factors, and clinical presentation. Epstein-Barr virus (EBV) infection and exposure to nitrosamines are the main known contributing risk factors for NPC. The highest risk demographic for NPC, however, is young men of Chinese and Southeast Asian descent. In this case report, we discuss a rare case of NPC in an adolescent African American male patient presenting with symptoms of temporomandibular disorder and with no known predisposing risk factors. <h3>CASE REPORT</h3> A 16-year-old African American male patient presented with initial symptoms of pain in the left temporomandibular joint (TMJ) and left angle of the mandible for 2 months. Lateral neck swelling and one episode of epistaxis were also reported. After a clinical exam and ultrasound examination, the diagnoses of temporomandibular disorder and peritonsillar abscess were considered. Antibiotics were prescribed and a month later multidetector computed tomography (CT) was ordered. The CT findings were significant for an infiltrative malignant nasopharyngeal mass with early skull base involvement and cervical lymphadenopathy. Subsequent magnetic resonance findings were significant for invasion of palatal, paraspinal, and masticatory muscles as well as the carotid sheath and V3 encasement with V3 perineural spread. Tissue sampling of the lesion was definitive for EBV-positive squamous cell carcinoma. The definitive diagnosis was NPC with TNM staging T4 N2c M0. Radiation and chemotherapy were then administered to the patient. Magnetic resonance imaging surveillance studies at 2 and 7 months showed continued tumor involution and lymphadenitis improvement with no evidence of progressive disease. <h3>DISCUSSION/CONCLUSIONS</h3> NPC in young African American patients is exceedingly rare. Nasopharyngeal soft tissue masses in young patients can be misinterpreted as hypertrophic adenoid tissue in cone beam computed tomography images. However, in the presence of unexplained symptoms such as TMJ pain, hearing loss, and epistaxis, a malignancy must be considered and investigated. Careful attention should be paid to skull base bony morphology and foramina for possible perineural spread when nasopharyngeal masses are present.