History Of Nasopharyngeal Carcinoma Research Articles

Endoscopic transnasal and transoral resection of the odontoid process and C1 combined with occipitocervical fusion for osteoradionecrosis of the upper cervical spine: a case report and literature review

BackgroundOsteoradionecrosis (ORN) of the upper cervical spine is a rare but severe complication of head and neck cancer radiotherapy. To raise awareness of this condition, we describe a patient with a history of nasopharyngeal carcinoma who developed ORN of the upper cervical spine and review the published literature reporting surgical management.Case presentationA 59-year-old female patient with persistent neck pain for one month and limited range of neck motion who had undergone radiotherapy for nasopharyngeal carcinoma with a total dose of 69.96 Gy 15 years ago presented to our hospital. The patient underwent endoscopic transnasal and transoral resection of the odontoid process and C1 anterior arch, combined with occipitocervical fusion. To better understand surgical management of ORN of the upper cervical spine, the literature published in the PubMed, Ovid MEDLINE, and Embase databases was reviewed. Our patient experienced alleviation of cervical pain and did not exhibit any postoperative complications. Since 2005, 11 cases of surgical management of ORN of the upper cervical spine (including the present case) have been published. Basilar invagination and/or atlantoaxial subluxation were observed in 4 /11 cases. Endoscopic procedures were performed in 4/11 cases, and occipitocervical fusion was performed in 8 /11 cases.ConclusionEndoscopic transnasal and transoral resection of the odontoid process and C1 anterior arch is a safe and effective treatment option for ORN of the upper cervical spine. Occipitocervical fusion is useful in patients with basilar invagination and atlantoaxial subluxation.

Impact of an Epstein-Barr Virus Serology-Based Screening Program on Nasopharyngeal Carcinoma Mortality: A Cluster-Randomized Controlled Trial.

Screening for nasopharyngeal carcinoma (NPC) has shown an improvement in early detection and survival rates of NPC in endemic regions. It is critical to evaluate whether NPC screening can reduce NPC-specific mortality in the population. Sixteen towns in Sihui and Zhongshan cities, China, were selected; eight were randomly allocated to the screening group and eight to the control group. Residents age 30-69 years with no history of NPC were included from January 1, 2008, to December 31, 2015. Residents in the screening towns were invited to undergo serum Epstein-Barr virus (EBV) viral capsid antigen/nuclear antigen 1-immunoglobulin A antibody tests; others received no intervention. The population was followed until December 31, 2019. Nonparametric tests and Poisson regression models were used to estimate the screening effect on NPC mortality, accounting for the cluster-randomized design. The trial is registered with ClinicalTrials.gov (identifier: NCT00941538). A total of 174,943 residents in the screening group and 186,263 residents in the control group were included. NPC incidence and overall mortality were similar between the two groups. A total of 52,498 (30.0% of 174,943) residents participated in the serum EBV antibody test. The overall compliance rate for endoscopic examination and/or biopsies among baseline and ever-classified high-risk participants was 65.9% (1,110 of 1,685) and 67.6% (1,703 of 2,518), respectively. A significant 30% reduction in NPC mortality was observed in the screening group compared with the control group (standardized NPC-specific mortality rate of 8.2 NPC deaths per 1,000 person-years versus 12.5; adjusted rate ratio [RR], 0.70 [95% CI, 0.49 to 0.997]; P = .048). This benefit was most evident among individuals age 50 years and older (RR, 0.56 [95% CI, 0.37 to 0.85]; P = .007) compared with those younger than 50 years (RR, 0.96 [95% CI, 0.64 to 1.46]; P = .856). In this 12-year trial, EBV antibody testing resulted in a significant reduction in NPC mortality.

Nasopharyngeal carcinoma with leptomeningeal metastases has been treated with comprehensive treatment for long-term survival: A case report and literature review.

Nasopharyngeal carcinoma has a high incidence in East and Southeast Asia, often with distant metastasis. However, leptomeningeal metastasis (LM) is extremely rare and usually has a poor prognosis. This paper reports the clinical treatment of a patient with meningeal metastasis of nasopharyngeal carcinoma (NPC) in order to improve the clinician's understanding of the disease. Early diagnosis of the disease can alleviate the pain of patients and prolong their survival time. We report the case of a 55-year-old female with a history of NPC with LM. Brain magnetic resonance imaging showed temporal lobe enhancement, peripheral edema, and enhancement of the adjacent meninges. Cerebrospinal fluid cytology suggests the presence of malignant tumor cells. The patient was diagnosed with LM from NPC. The patients were regularly given targeted therapy with nimotuzumab, immunotherapy with karyolizumab, and lumbar intrathecal methotrexate chemotherapy and supportive treatment. The patient had survived for 3 years since the diagnosis of LM and was in good condition and still under active antitumor treatment. Leptomeningeal metastasis of NPC is a rare disease. Although there is currently no unified treatment plan, the neurological symptoms can still be controlled and the quality of life can be improved through active treatment.

Epstein-Barr virus (EBV) DNAemia in saliva of viral encephalitis and nasopharyngeal carcinoma patients.

Epstein-Barr virus (EBV) is a lymphotropic virus that causes diseases ranging from a flu-like illness called infectious mononucleosis to nasopharyngeal carcinoma, Burkitt's lymphoma, and central nervous system (CNS) infection. Detection of EBV DNA is usually done using whole blood samples taken from the patients. We undertook the detection of EBV in blood, cerebrospinal fluid (CSF), and saliva by real-time quantitative PCR in two patients, one with a history of nasopharyngeal carcinoma, and the other having a case of viral encephalitis. EBV was detected only in saliva, whole blood in both patients, and CSF in the second case tested negative. This case series illustrates the importance of testing for EBV DNAemia in saliva by real-time polymerase chain reaction (PCR) to rule in a diagnosis of EBV.

Recurrent Orbital Subperiosteal Abscess in Patient with Nasopharyngeal Carcinoma

Introduction : Subperiosteal abscess (SPA) is a rare finding in cancer patients with orbital cellulitis. Severe complications associated with this condition are permanent visual loss, intracranial extension, and death.
 Case Illustration : A 38-year-old male with history of nasopharyngeal carcinoma (NPC) came with progressive right eyelid swelling, non-axial proptosis, and visual acuity was NLP. CT scan revealed right SPA associated with frontal sinusitis. NPC staging was T3N2M0. Despite the treatment of intravenous antibiotics and drainage incision of SPA, there was recurrence of right SPA two weeks after procedure and re-staging revealed T4N3M0. A joint operation with otolaryngology department to do debulking of the mass, frontal sinus surgery, and drainage incision was held. Culture resulted in Talaromyces marneffei. Patient was assessed with talaromycosis and given itraconazole for ten weeks. Moreover, patient came again with proptosis seven weeks postoperatively. Re-drainage incision was performed and clinical presentation was improved.
 Discussion : This case describes rare biological nature of NPC where extensive blockage of paranasal sinuses allows microorganism overgrowth and infection. The anatomical changes and cancer-related immunosuppression contribute to recurrent SPA. Chemotherapy and radiotherapy are ideal treatments for our patient, however, infection must be treated adequately first. Surgical interventionis needed to manage the infection by SPA drainage where antimicrobial has poor penetration into the abscess and debulking of tumor to clear the blockage of drainage pathway.
 Conclusion : Recurrent orbital SPA could happen in patients with NPC, therefore appropriate medical treatment and timely surgical intervention are essential in managing orbital SPA. Multidisciplinary management is required to optimize patient outcomes.

Double fatal consequences of distance metastasis in nasopharyngeal carcinoma after a completed chemoradiation in pregnancy: A case report.

Distant metastasis in nasopharyngeal carcinoma (NPC) patients is one of the reasons for the decreased life expectancy with the most common metastasis spreads are to the bone, liver, and lung. Hepatoma is the most frequent liver malignancy and is one of the highest causes of cancer death worldwide and this can be as a result of NPC metastasis. The aim of this case report was to present a patient with hepatoma in pregnancy as a result of NPC metastasis. A 34-year-old pregnant female at 24-25 weeks of gestation presented with a chief complaint of heartburn and unbearable pain radiating to the back. Previous medical history reported that the patient had a liver enlargement. The patient was G4P2A1 with a single living intrauterine fetus and active fetal movements. The patient has a history of NPC and received a completed chemoradiation one month prior to hospital admission. Physical examination showed bilateral rales and palpable diffuse multiple nodule masses in the upper right abdominal quadrant. Laboratory examination revealed anemia, thrombocytopenia, negative hepatitis B surface antigen (HBsAg), and elevated liver markers. Abdominal ultrasonography results showed multiple diffuse nodules in the liver. The patient was diagnosed with a metastatic hepatoma based on the clinical and imaging findings. During hospitalization, the patient repeatedly experienced pleural effusion with suspicion metastases. A few days later, the fetal movements stopped and the ultrasonography indicated negative fetal heart rate. After experiencing respiratory distress for hours, the patient expired the day after. This case highlights that due to the potential adverse effects of chemotherapy and radiotherapy, the initiation of these therapies should be carefully decided to avoid adverse effects to mother and fetus.

Compression of the Brain Stem and Cerebellar Peduncles: Nasopharyngeal Carcinoma Can Be Incriminated Too A Case Report

Nasopharyngeal carcinoma (NPC) is a distinct head and neck tumour associated with Epstein Barr virus infection. This case report describes a 60-year-old woman with a history of NPC who developed after an initial treatment, extensive skull base and intracranial invasion, causing compression of the brainstem and cerebellum, and cranial nerve palsies. Intracranial invasion is a prognostic factor indicating advanced disease, however direct compression of the brainstem by the tumour is not a frequent occurring.

Epidemiology, clinical presentations and radiologic findings of nasopharyngeal cancers

Background: The incidence and prevalence of malignant nasopharyngeal cancers (NPC) are different in each part of the world. The prevalence of this malignancy is about 0.5 in every 1000 people in the USA, while it is about 20 in every 100 people in China. this difference is due to nutritional, environmental, and genetic factors, especially for endemic regions. This malignancy is more common in men and is often seen in the sixth decade of life. We decided to do this study from the point of epidemiologic, clinical, and radiologic findings in patients with nasopharyngeal cancers. Methods: This is a cross-sectional descriptive study of patients who were admitted to the ENT ward with the diagnosis of nasopharyngeal carcinoma from 2004 to 2014. Thirty-two patients were studied from the point of age, gender, risk factors, clinical and radiologic findings. Results: Of 32 patients, 26 patients (%81) were male, and six patients (%19) were female. The mean age of the patients was 50.28 years old. Nineteen patients were self-employed, 4 were farmers, 3 were staffers, and 6 were house worker women. %84 of the patients had a negative family history of nasopharyngeal carcinoma. %66 of the patients had neck mass, and the second most common clinical finding was nasal obstruction. The most common site of tumor origin was the right lateral wall (%37), and the second was the left lateral wall (%28). Eight patients had erosion of the skull base, and 14 patients had tumor expansion to the paranasal sinuses and orbital cavity. Conclusion: In patients complaining of a neck mass, nasal obstruction, and headache, nasopharyngeal cancer should be highly suspected. Nasal endoscopy and biopsy of the suspected lesion are needed for correct diagnosis and treatment.

S2595 Solitary Liver Lesions Are Not Always HCC: Metastasis From an Uncommon Site Mimicking a Primary Liver Lesion

INTRODUCTION: Non-hepatocellular lesions may be found incidentally during imaging work-up for metastatic disease secondarily involving the liver, with metastatic tumors being the most common malignant neoplasms of the liver. The most common primary site of these metastasis is colorectal cancer, followed by breast, lung, and pancreas. Clinical history can be vital in the work-up of primary versus metastatic malignancy in tumors with less common sites of origin, especially when only a solitary liver lesion is identified and initially more suggestive of a primary liver lesion. CASE DESCRIPTION/METHODS: Seventy-two-year-old man who presented to the liver clinic for evaluation of a liver lesion seen on whole body scan (PET). Patient did not have prior history of liver disease or cirrhosis. He denied smoking, drinking alcohol or illicit drug use. He had no chronic or active hepatitis with good synthetic liver function (INR 1.1 sec, bilirubin 0.4 mg/ dL, albumin 4.2 g/dL, creatinine of 1.04 mg/ dL and alpha fetoprotein was less than 2 ng/ml). Past history significant for nasopharyngeal squamous carcinoma 3 years ago treated with chemoradiation. His last colonoscopy was unremarkable. PET scan showed interval appearance of the tracer avid low-attenuation lesion in the left lobe of the liver, segment 4A, concerning for primary neoplasm. He underwent a liver biopsy which showed poorly differentiated malignant cells. The malignant cells were positive for squamous markers p63 and CK5/6 on immunohistochemical stain (Image 1-2). In situ hybridization for EBV was also positive, consistent with metastatic non-keratinizing nasopharyngeal carcinoma. Patient was referred to oncology for further management. DISCUSSION: Liver metastases from head and neck cancer are rare (4.4%) and has a median survival of 4 months. When present in the liver, metastatic EBV-associated non-keratinizing nasopharyngeal carcinoma can histologically mimic hepatocellular carcinoma, neuroendocrine tumors, and small cell carcinoma. In the context of a solitary hepatic lesion on imaging, exclusion of hepatocellular carcinoma requires correlation with the patient's prior history and immunohistochemical staining on biopsy tissue. In this case, the known history of nasopharyngeal carcinoma helped to exclude the rare possibility of a primary squamous cell carcinoma of the liver, which has been proposed to arise following chronic irritation in patients with biliary cysts or stones, with resultant squamous metaplasia and malignant transformation.Image 1.: Liver biopsy showing positive immunohistochemical marker: Cytokeratin 5/6.Image 2.: Liver biopsy showing positive immunohistochemical marker: P53.

Late Dysphagia Following Radiotherapy After Nasopharyngeal Carcinoma: A Case Series.

Purpose Standard treatment for nasopharyngeal carcinoma (NPC) is radiation therapy (RT); however, long-term effects of RT frequently include significant swallowing impairments (dysphagia; Gaziano, 2002; Hui, Chan, & Le, 2018). Our objective was to describe swallowing physiology in consecutive outpatients with a history of NPC following RT using standardized methods. Understanding dysphagia characteristics in this patient population could ultimately inform rehabilitation strategies and improve patient outcomes. Method We conducted a retrospective, observational, descriptive study of consecutive outpatients undergoing videofluoroscopic swallowing (VFS) exams at our clinic, from 2009 to 2014. We included those with a diagnosis of NPC treated with RT. Those with other cancer diagnoses; previous tracheostomy; acute neurological injury; and progressive, degenerative neurological conditions were excluded. Two registered MBSImP clinicians, blinded to each other, reviewed and scored the VFS exams according to previously published methods (Martin-Harris et al., 2008). Following unblinding, a single reviewer collected demographic data from the electronic medical record. We reported overall impairment and MBSImP component scores descriptively. Results Of 158 outpatients undergoing VFS, 6 (N) met our inclusion criteria. The median time from completion of RT to outpatient VFS was 21.0 years. Patients reported a variety of dysphagia symptoms. All patients had high oral and pharyngeal residue scores (scores ≥ 2) and high impairment scores on components contributing to bolus transport and airway closure. Conclusions All patients presented with impairments in oral-pharyngeal bolus transport and airway protection. Our results identify specific swallowing impairments for this patient group highlighting possible latent RT effects on swallowing. This population would benefit from dysphagia rehabilitation and maintenance programs informed by multimodal diagnostic approaches.

Highly expressed CCR7 predicts poor prognosis in locally advanced nasopharyngeal carcinoma.

Nasopharyngeal carcinoma (NC) is a malignant human tumor with a high incidence that occurs on the top and lateral wall of the nasopharynx. To investigate the clinical value of chemokine receptor 7 (CCR7) in locally advanced NC. We enrolled 114 patients with locally advanced NC admitted to our hospital in the observation group (OBG) and 100 normal healthy subjects who underwent physical examination in the control group (COG). The serum CCR7 expression levels in each group were measured using enzyme-linked immunosorbent assay and were compared between the groups. None of the 114 patients or their family members were lost during follow-up. Thirty-five patients died within 3 years and 79 survived (survival rate: 69.29%). The serum CCR7 level was higher in the OBG than in the COG (P < 0.05). The receiver operating characteristic (ROC) curve showed that the area under the ROC curve (AUC) was 0.837 for diagnostic value for locally advanced NC and the AUC was 0.759 for predictive value for 3-year mortality. The CCR7 AUC for diagnosis of locally advanced NC was 0.837 and for prediction of mortality was 0.759. Univariate analysis revealed significant differences in smoking history, long-term consumption of pickled food, family history of NC, primary lesion staging, lymph node staging, distant metastasis, clinical pathological staging, and CCR7 between the two groups (P < 0.05). CCR7 was valuable in the diagnosis of locally advanced NC, and highly expressed CCR7 was predictive of poor prognosis.

Whole-Exome Sequencing Identified Multiple Germline Mutations of DNA Repair Pathway in Patients with and without a Family History of Nasopharyngeal Carcinoma

Whole-Exome Sequencing Identified Multiple Germline Mutations of DNA Repair Pathway in Patients with and without a Family History of Nasopharyngeal Carcinoma

An Unusual Presentation of Sensitive Skin Syndrome over the Lips of a Female Chinese Patient after Dental Procedure Managed and Improved with 0.03% and 0.1% Topical Tacrolimus Ointment Application as Assessed by the SS-10 Questionnaire

Sensitive skin syndrome (SSS) is a prevalent skin condition reported globally in most ethnic groups which may occur in any skin location. The cause and pathogenesis of SSS is still unresolved and controversial. Albeit the head and neck region including the face and scalp are reported as the commonest sites of SSS, the lips as the only region of the face affected has been rarely reported in the literature. We report a case of a 30 years old Chinese women with a positive family history of nasopharyngeal carcinoma who reported to have significant neurological, nociceptive and pruritoceptive symptoms solely over the lips lasting for more than one year complicated by psychological and sleep disturbances after dental procedure. She was followed up and monitored by the validated 10-items Sensitive Skin Scale questionnaire (SS–10) in the clinic setting, treated and managed by topical tacrolimus ointment, emollients, counselling, education and psychological supports.

Management of PEG Site Gastric Ulcer in a Patient with Large Hiatus Hernia and Massive Hematemesis

We describe the management dilemmas in a 72 year old lady who presented with massive haemetemesis after reinsertion of a dislodged Percutaneous Endoscopic Gastrostomy (PEG) tube. She had a history of nasopharyngeal carcinoma with multiple recurrences, and underwent wide field radiation therapy, left radical neck dissection and a left nasopharyngectomy. The patient was on long term feeding via a 20-Fr PEG tube. A new PEG tube was inserted over the existing tract after initial dislodgement. The patient presented 2 days later with large volume hematemesis and blood clots. Both a therapeutic gastroscope and a standard gastroscope could not cross the tight upper esophageal sphincter (UES). A Paediatric gastroscope was eventually used. A large Forrest IIb gastric ulcer at the antrum opposite the tip of the PEG tube, where it abutted the gastric mucosa (Image 1). Therapeutic options were limited given the smaller working channel, and removal of the adherent blood clot and hemoclip application could not be performed. A total of 7ml of adrenaline was injected into the ulcer edges with haemostasis achieved. Subsequent imaging revealed a large hiatus hernia with the gastric corpus and fundus located in the thorax. This resulted in a very limited space in the antrum and pylorus for new PEG tube insertion. Nasogastric tube could not be passed for feeding due to the prior instrumentation of nasopharynx and tight UES. A suitable anatomical space for new PEG tube insertion could not be found even with fluoroscopic guidance. Moreover, re-insertion of another PEG tube via the same tract would re-expose the patient to bleeding and perforation risks as the tip could erode the same ulcer. The decision was made to insert a 20-Fr low profile PEG tube via existing tract with the tip placed in the duodenum to reduce risk of further ulceration in the tight antrum. This PEG tube was used for insufflation of the stomach for insertion of a new 20-Fr definitive PEG tube at a different anatomical site 3 weeks later when the patient was more stable. Our case describes the successful usage of low profile PEG reinsertion for both interim feeding and as an aid for definitive PEG tube re-siting in the presence of hostile anatomy and limited treatment options.Figure 1

Carotid blowout syndrome after nasopharyngeal carcinoma radiotherapy: successful treatment by internal carotid artery occlusion after stent implantation failure.

IntroductionCarotid blowout syndrome (CBS) secondary to radiation therapy is life-threatening and requires emergency treatment. More recently, endovascular treatment has provided an effective way to control CBS-related bleeding.Case descriptionWe present a case of CBS with a rupture of the internal carotid artery (ICA) pseudo-aneurysm after Gamma Knife radiation therapy for nasopharyngeal carcinoma (NPC). The patient was a 55-year-old man who was transferred to our hospital with severe repetitive epistaxis. He had a history of NPC and had been treated with Gamma Knife radiation therapy 7 months prior, with a central dose of 32 Gy and marginal dose of 16 Gy. As CBS was confirmed by angiography, and the affected part of the ICA lumen exhibited moderate stenosis, the patient was successfully treated by ICA occlusion after stent implantation failure. The patient died 40 months after this operation from tumor recurrence, but without epistaxis during follow up.Discussion and EvaluationQuick selection of an appropriate treatment method is very important for an acute CBS patient.ConclusionICA occlusion can be directly considered for an acute CBS patient, if the affected ICA exhibits stenosis that is moderate or above.

Thyroid abnormalities in survivors of childhood cancer.

Ob­jec­ti­ve: To investigate the late side effects of childhood cancer therapy on the thyroid gland and to determine the risk factors for development of thyroid disorder among childhood cancer survivors.Methods: One hundred and twenty relapse-free survivors of childhood cancer (aged 6-30 years) were included in this study. The diagnoses of patients were lymphoma, leukemia, brain tumor, rhabdomyosarcoma and nasopharyngeal carcinoma (NPC). The patients were divided into two groups depending on the treatment: group 1-chemotherapy (ChT) only (n=52) and group 2-combination therapy of ChT + radiotherapy (RT) (head/neck/thorax) (n=68). Thyroid function tests, urinary iodine levels, and thyroid gland ultrasound examinations were evaluated in both groups.Results: Incidence of thyroid disease was 66% (n=79) in the survivors. The thyroid abnormalities were: hypothyroidism (HT) (n=32, 27%), thyroid nodules (n=27, 22%), thyroid parenchymal heterogeneity (n=40, 33%), autoimmune thyroiditis (n=36, 30%), and thyroid malignancy (n=3, 2%). While the incidence of HT and thyroid nodules in group 2 was significantly higher than in group 1, the incidence of thyroid parenchymal heterogeneity and autoimmune thyroiditis was similar in the two patient groups. HT and thyroid malignancy were seen only in group 2. In multivariate logistic regression analysis, a history of Hodgkin lymphoma (HL), brain tumor and NPC, as well as cervical irradiation and 5000-5999 cGy doses of radiation were found to constitute risk factors for HT. History of HL and 4000-5999 cGy doses of radiation were risk factors for thyroid nodules. Head/neck irradiation and treatment with platinum derivatives were risk factors for autoimmune thyroiditis. In univariate analysis, a history of NPC, cervical + nasopharyngeal irradiation, and treatment with platinum derivatives were risk factors for thyroid parenchymal heterogeneity.Conclusion: Our results indicate that there is especially an increased risk of HT and thyroid nodules in patients treated with combination therapy of ChT with head/neck/thorax RT. Although chemotherapeutic agents per se do not seem to cause HT, longer follow-up is needed to assess whether or not there is an increased risk for autoimmune thyroiditis and thyroid parenchymal heterogeneity after antineoplastic therapy.

Case-control study and nursing strategy on correlation factors of nasopharyngeal carcinoma in Guangzhou

Objective To investigate the correlation factors of nasopharyngeal carcinoma in Guangzhou.Methods A hospital-based 1:1 matched case-control study about nasopharyngeal carcinoma was conducted,calculated the factors associated with the extent of nasopharyngeal carcinoma and 95％ confidence interval.Results The analysis showed that barbecue food,pickled food,alcoholism,smoking,Cantonese,nasopharyngeal carcinoma history in immediate family,chronic rhinitis,psychic attack and EBV infection were risk factors of nasopharyngeal carcinoma (P=0.044,0.027,0.040,0.035,0.033,0.003,0.016,0.033,0.007); while eating vegetable and taking exercise frequently were protective factors (P=0.002,0.012).Conclusions Dietary factor,life-style,genetic factor,disease history and EBV infection are closely related to nasopharyngeal carcinoma in Guangzhou.It maybe helpful to decreasing the incidence of nasopharyngeal carcinoma and/or reducing the psychological burden of patients to take appropriate nursing countermeasures,a balanced diet and life-style,and keep a good mood by psychological counseling. Key words: Guangzhou; Nasopharyngeal carcinoma; Correlation factor

Multidisciplinary Treatment Approach in a Patient with History of Nasopharyngeal Carcinoma

Radiotherapy in NPC patients has side effects on the dentition, which affects quality of life dramatically. This case report presents multidisciplinary dental treatment approach in a 17-year-old male patient with a history of nasopharyngeal carcinoma (NPC), which was treated with chemotherapy and radiotherapy. The adolescent patient applied to dental hospital 4 years after the radiotherapy with aesthetic and functional problems on dentition affecting psychological, social, and physical aspects of his life. The dentition of the patient demonstrated the severe destruction as a devastating side effect of radiotherapy. With a successful multidisciplinary approach, our patient's aesthetics, function, and self-confidence were obtained. Well-established procedures, which include preventative care and maintenance, can reduce the duration and expenses of the treatment and help in challenging the life-long complications of radiotherapy.

Parafalcine Subdural Empyema in a Woman with Recurrent Acute Otitis Media

Subdural empyema (SDE) most frequently arises as a complication of paranasal sinusitis and is a serious intracranial infection. Parafalcine SDE, resulting from acute otitis media, is a rare phenomenon. Here, we report the case of 57 year old woman, with a history of nasopharyngeal carcinoma (NPC) with radiotherapy, 28 years ago and recent diagnosis of recurrent acute otitis media, who was admitted to the emergency department with a 2 days history of progressive right-sided limb weakness. Neurological examination revealed right-sided hemiparesis without meningeal signs. Non-enhanced computed tomography (CT) scans of the brain revealed a hypodense lesion in the left parafalcine region. Gadolinium-enhanced magnetic resonance imaging demonstrated layers of rim-enhancing subdural fluid collection and swelling of the surrounding brain, suggestive of empyema. The patient underwent surgical evacuation of empyema and was treated with intravenous antibiotics for 6 weeks. The patient recovered well without neurological deficits. Follow-up brain CT 6 weeks later showed complete resolution of previous lesions. Acute otitis media complicated by SDE is a rare clinical phenomenon that carries a high mortality rate. The complication risk may be higher in NPC patients following radiotherapy. Early diagnosis of SDE and prompt surgical evacuation of purulent material can result in a full recovery.

Accidental Finding of Bladder Cancer in 99mTc Methylene Diphosphonate Whole-Body Bone Scan

A 53-year-old woman with a history of nasopharyngeal carcinoma underwent (99m)Tc methylene diphosphonate (MDP) whole-body scintigraphy for tumor staging. An MDP-avid lesion located in the urinary bladder was found. Computed tomography showed a protruding mass with calcific surface in the left inferolateral wall of the urinary bladder. A biopsy was conducted and the pathological report confirmed the diagnosis of transitional cell carcinoma. The patient received transurethral resection and Bacillus Calmette-Guérin intravesical therapy. Four months later, she underwent an (18)F-FDG PET/CT scan. Unfortunately, tumor recurrence in the bladder cancer was diagnosed by the (18)F-FDG PET/CT scan.