Nasopharyngeal Carcinoma with Dural Metastasis Masquerading as Meningioma

Nur Saadah Mohamad,Ramiza Ramza Ramli

doi:10.24191/jchs.v7i1.10250

Nur Saadah Mohamad, Ramiza Ramza Ramli

Open Access

https://doi.org/10.24191/jchs.v7i1.10250

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Abstract

Nasopharyngeal carcinoma (NPC) is one of the commonest head and neck malignancies in South East Asia. The tumor arises from epithelial layer of the nasopharynx, found most frequently at the Fossa of Rosenmuller (FOR). NPC can spread to its adjacent structures and cause distant metastasis. However, the occurrence of dura metastasis is uncommon despite being closely located. Consequently, a lesion of the dura may be misdiagnosed as meningioma, especially when it presents with a dural tail sign in the Magnetic Resonance Image (MRI). We reported a case of a 48-year-old lady with progressive right eye diplopia and blurry of vision which later on MRI noted an extensive base of skull mass at the petroclival, suprasellar and orbital apex with adural tail Meningioma was the primary diagnosis until tissue biopsy of the nasopharynx and posterior part of inferior turbinate later revealed as nasopharyngeal carcinoma, non-keratinizing type.

Highlights

Nasopharyngeal carcinoma (NPC) is one of the common head and neck malignancies in Malaysia
Magnetic Resonance Image (MRI) revealed an extensive base of skull lesion (Figure 1) and based on this finding, meningioma was the primary lesion which left us baffled when the tissue biopsy result revealed otherwise
The absence of nasal and ear symptoms as well as cervical lymphadenopathy that typically found in the nasopharyngeal carcinoma poses a challenge in diagnosing and initiation of treatment

Summary

INTRODUCTION

Nasopharyngeal carcinoma (NPC) is one of the common head and neck malignancies in Malaysia. A 48-year-old lady with underlying bronchial asthma presented to Ophthalmology Clinic in our centre with a complain of progressively blurring of right vision for eight months It was associated with diplopia and convergence squint which affected her daily activities. Considering the rapid progress of the symptoms which indicative of a tissue biopsy to exclude the malignant type of meningioma was needed. She was referred to the otorhinolaryngology (ORL) team for a more approachable biopsy of the lesion via an endoscopic endonasal trans-sphenoidal approach as compared to the open cranial surgery due to the epicenter of the tumor mass which located at the sphenoidal area. The nasopharyngeal carcinoma was staged as a T4N0M1 and she is currently undergoing treatment with concurrent chemoradiotherapy (CCRT)

Findings

DISCUSSION

CONCLUSION