Nasopharyngeal Malignancy Research Articles

Nasopharyngeal tumors with unusual presentations: a retrospective analysis from Saudi Arabia

The most common malignant lesion in the nasopharynx is the nasopharyngeal carcinoma (NPC), commonly presents with painless upper cervical lymphadenopathy secondary to nodal metastasis and the undifferentiated type is the most common diagnosis. Compared with other types of cancers, NPC is uncommon, albeit with a high difference in geographical distribution where the worldwide cases account for only 0.6% of all annually diagnosed cancers diagnosed, however, in Saudi Arabia the overall incidence among all age groups is 0.1–0.13 per 10 000. Other rare types of malignancies are also seen at the nasopharynx and due to the nonspecific clinical and imaging characteristics; the preoperative diagnosis may be difficult. This study retrospectively assessed the nasopharyngeal tumors diagnosed in a referral hospital in Al-Baha regions, Saudi Arabia during 10 years period that came with unusual presentations at the level of clinical, radiological, or pathological features to raise the awareness of healthcare provides by these entities. Twenty patients were included and revealed unusual (atypical) clinical presentation in 50% of case including a case presented with respiratory symptoms as a first presentation where multiple lung foci were seen and proved to be a metastatic NPC. Histopathological diagnoses were challenging for 40% of the cases revealing unusual malignant types. In summary, however, the nasopharyngeal malignancy is a rare entity, accurate diagnosis may be missed in clinical or even in the pathology examination. Surgeons and pathologists should be aware of the unusual presentation to provide early and more accurate diagnosis for such serous tumors.

High levels of soluble P-selectin, neutrophil extracellular traps, and myeloperoxidase as risk factor of deep vein thrombosis in malignancy patients receiving platinum-based chemotherapy

Backgrounds Venous Thromboembolism (VTE) is a disease entity comprising Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE). VTE events increase the mortality rate of patients with cancer receiving platinum-based chemotherapy. Soluble P-Selectin, Neutrophil Extracellular Traps (NET), and myeloperoxidase (MPO) are risk factors associated with DVT in malignancy patients receiving platinum-based chemotherapy. The purpose of this study was to determine the role of soluble P-selectin, NET, and MPO as risk factors for DVT in patients with malignancy receiving platinum-based chemotherapy. Patients and Methods This study used a case-control design (matched pair case-control study) based on age and gender. The case group consisted of subjects with DVT, whereas the control group consisted of subjects without DVT. The subjects were 31 in each case and control groups. Soluble P-selectin, NET, and MPO levels were measured in each group. Results The mean age of case group was 50.26±12.15 years meanwhile in control group was 52.81±11.64 years. In the case group, 71% of the subjects were female, whereas 51.6% of the control group were male. Most subjects, either in the case group (71%) or the control group (71%), used carboplatin. In the case group, cervix malignancy was the most common malignancy (32.3%), whereas in the control group, it was nasopharyngeal malignancy (25.8%). High soluble P-selectin level was a risk factor for DVT (OR 3.38, CI 1.180 – 9.780, p=0.02). A high NET level was also a risk factor for DVT (OR 2.88, CI 1.026-8.074, p=0.04). The high MPO levels in this study could not be proven as a risk factor. Conclusions Soluble P-selectin and NET are risk factors that play a role in the pathophysiology of DVT through the pathomechanism of immunothrombosis induced by endothelial injury and activation of monocytes and neutrophils due to the use of platinum-based chemotherapy.

Head and neck cancer pain

Background: Pain is a condition that often occurs in patients with head and neck cancer. Pain in patients with malignancy occurs mostly due to metastatic processes. Method: This research is a cross-sectional descriptive study to measure variables using the VAS, BPI, HADS, and LANSS questionnaires. Result: 127 subjects met the inclusion and exclusion criteria. Most patients with were male (63.8%), with the most ages being in the 46–55 year group (33.9%). Most patients were in stage III (48%), with the most diagnosed being nasopharyngeal malignancy (42.5%). About 60.6% of patients have received pain management according to WHO Step 2 and most suffered from neuropathic pain (65.8%) with the most pain intensity being moderate pain (53.5%). Pain interfered most with activities (91.3%) and as many as 64.6% experienced depression. Conclusion: A description of pain in head and neck patients is needed for good management of malignancy and pain management.

Patterns of Distant Metastasis in Head and Neck Cancer in a Tertiary Care Centre.

Objectives/Hypothesis To find out the frequency and location of distant metastasis in head and neck malignancies. Our study also aims to find out the most common site leading to distant metastasis and the management of these distant metastasis cases. Methods 1558 patients treated for head and neck malignancy between 2017 and 2021 were retrospectively reviewed. The frequency and proportions were used to produce descriptive statistics. Results The highest number of head and neck malignancy cases were reported in the oral cavity which included 943 cases (60.52%). Patients with distant metastasis (M1) accounted for 4.73 percent of all cases (n = 90). Nasopharyngeal malignancy cases showed the highest M1 frequency (29.03%), whereas oral cavity patients had the lowest frequency (2.75%). The most common site of distant metastasis was in the lung (64%) followed by bone (18%) and the liver (11%). CT scan of the neck and thorax was the most commonly used diagnostic modality. The most common histopathological finding was squamous cell carcinoma (85%). Multimodality treatment was employed for most of the detected cases. Conclusion Distant metastasis at presentation is rare in head and neck cancer. The rate of distant metastasis in the present study was 4.73%, with the lung being the most common site. The overall survival of these patients depends on a variety of factors and more studies are needed in this regard.

Histoplasmosis in nasopharynx clinically mistaken for nasopharyngeal malignancy

Abstract Histoplasmosis is a rare type of fungal infection which may manifest as a respiratory disease or as a disseminated infection. It is common in immunocompromised patients and, in recent times, seen in association with COVID-19. On histopathological examination, many intracellular and extracellular yeast forms are seen, which can be confirmed by fungal stains. Histoplasmosis involving the nasopharyngeal region is quite rare. Till date, only less than 100 cases of pharyngo-laryngeal histoplasmosis have been reported. Such cases are clinico-radiologically easily and frequently mistaken for malignancy. Here, we report a case that initially had COVID-19-like symptoms and later presented with a nasopharyngeal mass clinico-radiologically mistaken as a nasopharyngeal malignancy. The diagnosis was established on histopathological examination and the patient recovered completely with anti-fungal treatment. A high grade of suspicion and thorough histopathological examination, especially in immunocompromised patients, complimented by fungal special stains is quite rewarding as even a disseminated disease is curable.

Prevalence of EBV infection in 1157 diseased cohorts in Nigeria: A systematic review and meta-analysis

BackgroundEpstein-Barr virus (EBV) is a member of the herpesvirus family that is known to ubiquitously infect people worldwide. However, the actual prevalence of EBV infection in diseased patients in Nigeria, remains unknown. This study was thus conducted to ascertain the true prevalence. MethodsA systematic review and meta-analysis of published data was conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Electronic databases including PubMed, Scopus, ScienceDirect, and Google Scholar were searched for studies reporting the occurrence of EBV infection among patients with established diseases. Studies were included if they assessed EBV infection in diseased patients in Nigeria. Data were extracted and subsequently analysed using R software. Funnel plot and Egger's regression test was used to assess publication bias, while JBI prevalence tool was used to assess study quality. ResultsA total of 13 studies covering 228 cases of EBV infection among 1157 diseased patients were included. Summary estimates were computed using random-effects model. The pooled prevalence of EBV infection was 20.3% (95% CI: 10.8–34.9, I2 ​= ​92.26, p ​< ​0.001). When stratified according to the type of disease, higher estimates were obtained for patients suffering from Kaposi's sarcoma (98.7%, 95% CI: 82.2–99.9) and Nasopharyngeal malignancy (85.7%, 95% CI: 70.0–93.9). A prevalence of 13.4% (95% CI: 6.0–27.4) and 12.2% (95% CI: 4.8–27.8) was derived for the most reported patient populations, lymphoma and HIV, respectively. ConclusionThis first meta-analysis on the prevalence of EBV among Nigerian patients suffering from various diseases reveals a prevalence that emphasises the need to routinely monitor EBV infection in all EBV-associated diseases in Nigeria.

Diagnosis of possible nasopharyngeal malignancy in adults with isolated serous otitis media; a systematic review and proposal of a management algorithm.

The objective of this study was (1) to systematically review the evidence of routine post-nasal space blind biopsies and/or imaging of adults with isolated serous otitis media (SOM) of unknown cause for detection nasopharyngeal malignancy (NPM), and (2) to design a clinical management algorithm for these patients. A systematic search was conducted in the databases PubMed, Embase and Cochrane Library guided by the study question "Should adults with isolated SOM of unknown cause undergo routine biopsies of the post-nasal space and/or diagnostic imaging for detection of NPM?". All retrieved studies were reviewed and quantitatively analyzed. The systematic literature search identified 552 publications accessible for title-abstract screening. This yielded 23 studies for full text assessment, of which 6 were found eligible for inclusion. All six studies dealt with nasopharyngeal blind biopsies, whereas no studies on cross-sectional imaging were identified. The derived summarized results of the included studies showed that 5.5% (31/568) of patients with isolated SOM of unknown cause were diagnosed with NPM. Of these, 6.5% (2/31) had normal nasopharyngeal endoscopy (i.e., malignancy was discovered by blind biopsies). Finally, 0.35% (2/568) of patients with isolated SOM of unknown cause diagnosed with NPM had normal nasopharyngeal endoscopy findings (i.e., nasopharyngeal endoscopy ruled-out malignancy in 99.65% of patients). We found no evidence supporting routine use of blind biopsies or cross-sectional imaging in adults with isolated serous otitis media of unknown cause. We propose a pragmatic management algorithm for workup of adults with persistent secretory otitis media.

Nasopharyngeal Tuberculosis mimicking Nasopharyngeal Carcinoma: A Case Series.

Tuberculosis is a highly contagious granulomatous disease which is endemic in South East Asia. Most common presentation is pulmonary tuberculosis which is spread by droplets inhalation of mycobacterium tuberculosis bacterium. Nasopharyngeal tuberculosis is a rare entity which poses a diagnostic difficulty as its presentation is greatly similar to that of nasopharyngeal carcinoma. Herein, we describe two cases of nasopharyngeal tuberculosis which mimics nasopharyngeal malignancy leading to diagnostic difficulties.

The Influence of Hospital Volume on the Outcomes of Nasopharyngeal, Sinonasal, and Skull-Base Tumors: A Systematic Review of the Literature.

Objective The center of excellence model of health care hypothesizes that increased volume in a specialized center will lead to better and more affordable care. We sought to characterize the volume-outcome data for surgically treated sinonasal and skull base tumors and (chemo) radiation-treated nasopharyngeal malignancy. Design Systematic review of the literature. Setting This review included national database and multi-institutional studies published between 1990 and 2019. Participants PubMed was interrogated for keywords "hospital volume," "facility volume," and outcomes for "Nasopharyngeal carcinoma," "Sinonasal carcinomas," "Pituitary Tumors," "Acoustic Neuromas," "Chordomas," and "Skull Base Tumors" to identify studies. Single-institution studies and self-reported surveys were excluded. Main outcome measures The main outcome of interest in malignant pathologies was survival; and in benign pathologies it was treatment-related complications. Results A total of 20 studies met inclusion criteria. The average number of patients per study was 4,052, and ranged from 394 to 9,950 patients. Six of seven studies on malignant pathology demonstrated improved survival with treatment in high volume centers and one showed no association with survival. Ten of thirteen studies on benign disease showed reduced risk of complications, while one study demonstrated both an increased and decreased association of complications. Two studies showed no volume-outcome associations. Conclusion This systematic review demonstrates that a positive volume-outcome relationship exists for most pathologies of the skull base, with some exceptions. The relative dearth of literature supports further research to understand the effect of centralization of care on treatment outcomes.

Igg4 Related Disease of Skull Base-A Diagnostic Challenge.

IgG4 related disease (IgG4-RD) is a fibro-inflammatory disease, with tendency to affect any organ of the body. However, few cases affecting the skull base have been reported in literature. We report one such case in an elderly male, who presented us with a mass lesion in the skull base that mimicked nasopharyngeal malignancy. On thorough clinical history, examination, and investigations, IgG4 Related disease was diagnosed and treatment was started for it. The patient responded well to the treatment and is on follow up.

Fungal nasopharyngitis masquerading as nasopharyngeal mass in an immunocompetent patient: a case report

&lt;p&gt;&lt;span&gt;Isolated nasopharyngeal candidiasis in an immunocompetent host, has not been reported in literature. This is a case of a 48 year old lady with no comorbidities who presented with a mass in the nasopharynx mimicking nasopharyngeal malignancy. Endoscopic debridement and biopsy revealed necrotic tissue with fungal ball composed of filamentous hyphae suggestive of aspergillus and budding yeast form of Candida. A diagnosis of fungal nasopharyngitis was made and started on antifungal therapy for 6 weeks following which patient is relieved of symptoms.&lt;/span&gt;&lt;/p&gt;

Abstract 5192: EBV-associated histone modifications regulate DNA damage repair pathway and associate with cisplatin resistance in nasopharyngeal epithelial malignancy

Abstract Introduction: Epstein-Barr virus (EBV) infection is associated with various cancers. Some studies have confirmed EBV can induce hypermethylation to suppress the expression of several key cancer-related genes in gastric cancer. Previously, we showed that nasopharyngeal carcinoma (NPC), an EBV-associated malignancy, is characterized by low mutation rate, but harbors extensive hypermethylation compared with other cancer types. Also, the de novo methylated regions in NPC extensively overlap with the histone bivalent marks (H3K4me3 and H3K27me3) derived from human embryonic stem cells . This suggests an important role of EBV in regulating histone modifications in NPC development. Hence, further studies focusing on the EBV-associated histone modifications are necessary. Aim: This study aims to elucidate the role of EBV in regulating a transcription-activation histone mark (H3K4me3) and a suppressive mark (H3K27me3) in nasopharyngeal epithelial (NPE) cells. Methodologies: Two pairs of EBV+/- NPE cell lines were used for chromatin immunoprecipitation sequencing (ChIP-Seq) to identify the genes regulated by EBV-associated histone modifications. ChIP-QPCR and RT-QPCR were utilized to validate the ChIP-Seq results. The candidate genes and pathways identified from the ChIP-Seq results were validated by in vitro and in vivo functional studies. Results: A panel of 16 DNA damage repair family members were identified with significant reduction of H3K4me3 in the EBV+ NPE cells. One of the candidate genes, MLH1, was validated with down-regulation in the EBV+ NPC cell lines and NPC specimens, and the expression level was demonstrated to associate with cisplatin resistance. Also, the base excision repair (BER) pathway was significantly enriched with reduction of H3K4me3 after EBV infection. Down-regulation of the 7 members from BER was validated in the EBV+ NPE cell lines and NPC specimens. The defective DNA damage repair in the EBV+ NPE cell lines was further validated by the comet assay. Furthermore, after EBV infection, gain of H3K27me3 in MLH1 and the 7 members from BER pathway was identified by ChIP-QPCR. Interestingly, our results from bisulfite sequencing reveals that the promoter regions of the candidate genes are hypomethylated in both EBV +/- NPE cells. Conclusion: EBV modulates histone bivalent marks independent of the promoter DNA methylation status to regulate DNA damage repair in the host cells. Acknowledgements: This work was supported by the Research Grants Council of the Hong Kong Special Administrative Region, People’s Republic of China: Grant number AoE/M-06/08 to MLL and Seed Funding Programme for Basic Research of HKU 201308159003 to AKLC. Citation Format: Merrin Man Long Leong, Arthur Kwok Leung Cheung, Wei Dai, Sai Wah Tsao, Maria Li Lung. EBV-associated histone modifications regulate DNA damage repair pathway and associate with cisplatin resistance in nasopharyngeal epithelial malignancy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 5192.

Impact of nasopharyngeal irradiation and gadolinium administration on changes in T1 signal intensity of the dentate nucleus in nasopharyngeal malignancy patients without intracranial abnormalities.

Irradiation has been found to increase T1 signal intensity (SI) of the dentate nucleus (DN) by accelerating the gadolinium deposition in patients after multiple gadolinium-based contrast agent (GBCA) administrations. Several reports have focused on this phenomenon in patients with brain tumors; however, data in patients receiving irradiation with no intracranial abnormalities (NIAs) are lacking. To explore how nasopharyngeal irradiation affected SI changes on unenhanced T1 -weighted imaging (T1 WI) in the DN in nasopharyngeal malignancy (NPM) patients who presented with NIAs and who had multiple injection doses (IDs) of linear GBCAs. Single-center, retrospective, case-control study. In all, 132 subjects: 66 NPM patients, 66 matched controls. 1.5T and 3T/T1 WI, T2 WI, and fluid-attenuated inversion recovery (FLAIR). Radiation doses (RDs) were calculated by a radiotherapy technician. SIs were measured by a radiologist. The DN-to-cerebellar white matter (CWM) SI ratios and their relative percentage change (Rchange ) were compared. Shapiro-Wilk test, paired t-test, independent t-test, Mann-Whitney U-test, Pearson and Spearman correlation. DN/CWM b ratios or R change from the NPM group were significantly higher than those from the control group (P < 0.001). No significant difference of DN/CWM a ratios was found between the two groups (P > 0.05). Positive correlations between R change , DN/CWM b ratio, and the number of IDs were found in both the NPM and control groups (P < 0.01). The overall changes of DN/CWM b ratio or R change between NPM and control groups were higher for the higher-IDs subgroup (≥10) than for the lower-IDs subgroup (<10). Nasopharyngeal irradiation appeared to increase SI in T1 WI in NPM patients with NIAs and repeated GBCA administrations relative to control patients who also underwent GBCA administrations, especially when IDs ≥10. However, no significant association between R change and RDs to the DNs was found. 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:250-259.

Development and validation of an endoscopic images-based deep learning model for detection with nasopharyngeal malignancies

BackgroundDue to the occult anatomic location of the nasopharynx and frequent presence of adenoid hyperplasia, the positive rate for malignancy identification during biopsy is low, thus leading to delayed or missed diagnosis for nasopharyngeal malignancies upon initial attempt. Here, we aimed to develop an artificial intelligence tool to detect nasopharyngeal malignancies under endoscopic examination based on deep learning.MethodsAn endoscopic images-based nasopharyngeal malignancy detection model (eNPM-DM) consisting of a fully convolutional network based on the inception architecture was developed and fine-tuned using separate training and validation sets for both classification and segmentation. Briefly, a total of 28,966 qualified images were collected. Among these images, 27,536 biopsy-proven images from 7951 individuals obtained from January 1st, 2008, to December 31st, 2016, were split into the training, validation and test sets at a ratio of 7:1:2 using simple randomization. Additionally, 1430 images obtained from January 1st, 2017, to March 31st, 2017, were used as a prospective test set to compare the performance of the established model against oncologist evaluation. The dice similarity coefficient (DSC) was used to evaluate the efficiency of eNPM-DM in automatic segmentation of malignant area from the background of nasopharyngeal endoscopic images, by comparing automatic segmentation with manual segmentation performed by the experts.ResultsAll images were histopathologically confirmed, and included 5713 (19.7%) normal control, 19,107 (66.0%) nasopharyngeal carcinoma (NPC), 335 (1.2%) NPC and 3811 (13.2%) benign diseases. The eNPM-DM attained an overall accuracy of 88.7% (95% confidence interval (CI) 87.8%–89.5%) in detecting malignancies in the test set. In the prospective comparison phase, eNPM-DM outperformed the experts: the overall accuracy was 88.0% (95% CI 86.1%–89.6%) vs. 80.5% (95% CI 77.0%–84.0%). The eNPM-DM required less time (40 s vs. 110.0 ± 5.8 min) and exhibited encouraging performance in automatic segmentation of nasopharyngeal malignant area from the background, with an average DSC of 0.78 ± 0.24 and 0.75 ± 0.26 in the test and prospective test sets, respectively.ConclusionsThe eNPM-DM outperformed oncologist evaluation in diagnostic classification of nasopharyngeal mass into benign versus malignant, and realized automatic segmentation of malignant area from the background of nasopharyngeal endoscopic images.

Abstract 5759: Histopathologic patterns of nasopharyngeal malignancy in Lagos, Nigeria and its association with Epstein-Barr virus (EBV): A 10-year retrospective study

Abstract Background: Nasopharyngeal cancer (NPC) is a rare cancer worldwide. It is now found to be increasing in incidence in Nigeria, though the incidence is lower when compared to countries in the Mediterranean basin, North Africa and Southeast Asia. NPC is frequently associated with Epstein-Barr virus (EBV), but no previous study has been done in Lagos to document the association. Objective: To determine the prevalence, histologic types and age distribution of nasopharyngeal malignancy in Lagos University Teaching Hospital (LUTH) and its association with EBV over a period of 10 years, between January 2003 to December 2012. Materials and Methods: Slides and formalin-fixed paraffin-embedded (FFPE) tissue blocks, hospital request forms, referral cards, patients’ case notes and duplicate copies of histopathology reports of cases of histologically diagnosed nasopharyngeal malignancy in the Anatomic and Molecular Pathology department of LUTH within the study period were retrieved. The cases were reclassified into epithelial and non-epithelial malignancies. The epithelial malignancies were reclassified according to WHO classification. Immunohistochemistry (IHC) for EBV latent membrane protein-1 (LMP-1) was carried out on cases with viable FFPE to evaluate the prevalence of the virus in Nasopharngeal malignancy. Results: A total of 75 histologically confirmed cases of nasopharyngeal malignancy were seen during the study period, which constituted 1.1% of the total cancer recorded in this center. There were 47 males (63%) and 28 females (37%) with a male to female ratio of 1.7:1. The age ranged from 3 to 75 years, mean age was 44.1 years, the peak age group was 40 -49 years for males and 50 - 59 years for females. On histological classification, undifferentiated carcinoma (WHO type III) was the commonest (49.3%), differentiated non-keratinizing squamous cell carcinoma, SCC (WHO type II) and keratinizing SCC (WHO type I) accounted for 24% and 9.3% respectively. Thus, NPC accounted for 82.6% of the total cases of nasopharyngeal malignancy seen. Other histological types seen were non-Hodgkin lymphoma (NHL) 13.3%, well differentiated adenocarcinoma 2.7% and low grade mucoepidermoid carcinoma 1.3%. EBV LMP-1 IHC was positive in 30 (86%) out of the 35 cases studied. These consisted of 14 undifferentiated carcinoma, 5 NHL, 2 adenocarcinoma, 7differentiated non-keratinizing SCC (WHO type II) and the 2 cases of keratinizing SCC (WHO type 1). Conclusion: Nasopharyngeal malignancy is not uncommon in this environment. It occurred more frequently in males than females with the peak age of incidence at 5th decade of life, undifferentiated carcinoma (WHO type III) is the commonest histologic type and it is highly associated with EBV. Note: This abstract was not presented at the meeting. Citation Format: Oladipo Omoseebi, Olakanmi Akinde, Omobolade Obadofin, Nzechukwu Ikeri, Gabriel Ogun, Adekumbiola Banjo. Histopathologic patterns of nasopharyngeal malignancy in Lagos, Nigeria and its association with Epstein-Barr virus (EBV): A 10-year retrospective study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5759. doi:10.1158/1538-7445.AM2017-5759

Epidemiology of oral, salivary gland and pharyngeal cancer in children and adolescents between 1970 and 2011

ObjectivesThe age of oral and pharyngeal cancer patients has reportedly decreased over the last decade, but most of the peer-reviewed literature regarding oral and pharyngeal cancer in individuals 0–19years of age (Y) is limited to specific tumor sites and/or types, or a small number of cases. Our aim is to characterize oral, salivary gland and pharyngeal cancer (OSPC) in 0–19Y in order to improve knowledge of the disease in young individuals. MethodsData on OSPC between 1970 and 2011 was taken from the Israel National Cancer Registry, and included patient age, gender, tumor site and tumor type. Data analysis was performed by using IBM SPSS, Winpepi software and Joinpoint Regression Program. alpha<0.05 was deemed statistically significant. ResultsA total of 13,863 OSPC cases were diagnosed with 2.6% (N=357) of 0–19Y. The male to female ratio was 1.5:1. The rates of diagnosis decreased between 1991 and 2011 and were not significantly different between the genders. The nasopharynx was the leading tumor site (42.3%) followed by the salivary glands (20.5%), and both were more common in 14–19Y. The tonsils and other pharyngeal sites were common among 0–13Y. The main tumor types were lymphomas (20.7%) and carcinomas (19.9%). ConclusionsThe general characteristics of OSPC remained unchanged over the last four decades. This may imply that environmental factors have not had any effect. Males are affected more than females and might have a genetic predisposition for nasopharyngeal malignancy. Health care providers should be aware of the common sites and tumor types among children and adolescents.

Association of Epstein–Barr Virus (EBV) with malignancy of the nasopharynx in Lagos, Nigeria

Background: Nasopharyngeal cancer is a rare cancer worldwide. It is now found to be increasing in incidence in Nigeria, though the incidence is lower when compared to countries in the Mediterranean basin, North Africa and Southeast Asia. This cancer is frequently associated with Epstein-Barr virus (EBV), but no previous study was done in this centre to document the association. Aim and Objectives: To assess the EBV status in Nigerian patients with nasopharyngeal cancer by using Latent membrane protein – 1 immunohistochemistry. ( LMP-1IHC). Materials and Methods: Thirty-five (35) out of Seventy-five (75) histologically-confirmed cases of nasopharyngeal malignancy (NPM) seen in the Department of Anatomic and Molecular Pathology of Lagos University Teaching Hospital, Lagos between January 2003 and December 2012 were available for EBV study using LMP-1 IHC. Results: EBV LMP-1 IHC was positive in thirty (86%) out of the thirty-five cases studied and these consisted of, 14 cases of undifferentiated carcinoma (WHO type 3), 5 cases of non-Hodgkin lymphoma and 2 cases of adenocarcinoma. Also seven out of eleven cases of differentiated non-keratinizing squamous cell carcinoma (WHO type 2) were EBV positive and two of the three cases of keratinizing squamous cell carcinoma (WHO type 1) were EBV positive. Conclusion: This study has shown that nasopharyngeal malignancy in our centre is highly associated with EBV latency as detected by LMP-1 immunohistochemistry.

Prevalence of Nasopharyngeal Carcinoma among Patients with Nasopharyngeal Mass in a Philippine Tertiary Training Hospital

Objectives: To determine the prevalence and identify the types of Nasopharyngeal Carcinoma (NPCA) among patients with nasopharyngeal mass seen at a tertiary university training hospital in the Philippines from January 2006 – July 2012 and identify possible factors associated with nasopharyngeal carcinoma.&#x0D; Methods: A retrospective cross-sectional study was performed at a tertiary university training hospital among cases (n=179) seen with nasopharyngeal mass at the ENT outpatient department. Histopathology results and patient medical charts were collected and reviewed after IRB approval. The age at diagnosis, sex, place of residence, occupation and chief complaint was compared among patients with positive histopathology of NPCA only.&#x0D; Design: Retrospective, cross sectional study&#x0D; Setting: Tertiary Private University Training Hospital&#x0D; Participants: 179 patients with nasopharyngeal mass&#x0D; Results: 96 (54%) cases with nasopharyngeal mass seen at the ENT outpatient department were positive for nasopharyngeal malignancy. The remaining 83 (46%) cases with nasopharyngeal mass had a benign histopathology. NPCA was more common among males (58%) than females (42%). The most common form of NPCA was non-keratinizing undifferentiated NPCA (47%) followed by poorly differentiated squamous cell carcinoma in 18 (19%). The most common chief complaint was a neck mass, followed by decreased hearing.&#x0D; Conclusion: There was a higher proportion of nasopharyngeal malignancy among male patients with nasopharyngeal mass, and the most common chief complaint was a neck mass. Future research should integrate data with other hospital institutions to obtain more accurate demographic data of the local prevalence of NPCA. A detailed record of the ethnicity, diet, occupation, smoking history and family history of cases should be obtained to correlate possible risk factors of NPCA among patients with nasopharyngeal mass in our setting.&#x0D; &#x0D; &#x0D; Keywords: Nasopharyngeal carcinoma, nasopharyngeal mass, epidemiology, prevalence&#x0D; &#x0D;

A Possible Cause of Nasolacrimal Duct Obstruction: Narrow Angle Between Inferior Turbinate and Upper Part of the Medial Wall of the Maxillary Sinus

Background: To search the relationships between the primary nasolacrimal duct obstruction and the angle between the bony inferior turbinate and upper part of the medial wall of the maxillary sinus.Design: Retrospective study.Participants and methods: Computed tomography findings of 35 patients with primary nasolacrimal duct obstruction and 100 sides of 50 individuals were reviewed. While the study group was composed of patients who had external dacryocystorhinostomy surgery, the control group was composed of patients who had CT scans due to headache, sinusitis and smell dysfunction. Epiphora complaint was evaluated with the lacrimal syringing. The exclusion criteria were: age less than 20 years, previous nose, sinus, turbinate or lacrimal surgery, prior history of maxillofacial fracture, nasopharyngeal malignancy, reflex hypersecretion, and associated pathology of the lacrimal canaliculi.Main outcome measures: The angle of inferior turbinate.Results: The mean angles were 53.2° (range, 37.9–82.9°) for affected side of the study group, 58.6° (range, 32–85.3°) for the unaffected side of the study group and 56.8° (range, 41.2–76.9°) in the control group. The difference between the angles was statistically significant between the study and the control groups (p < 0.05). The difference between the operated and non-operated sides of the study group was also statistically significant (p < 0.05).Conclusion: Although this study was performed in a small group, we thought that the narrow angle between the bony inferior turbinate and upper part of the medial wall of the maxillary sinus might be a possible causative factor in primary acquired nasolacrimal duct obstructions.

Nasopharyngeal biopsy in adults: a large-scale study in a non endemic area.

Limited data exist on the referral criteria for endoscopic-guided nasopharyngeal biopsy to rule out nasopharyngeal malignancy among adults in a non-endemic area. Retrospective study of all adult patients that had been referred to our outpatient clinic to undergo endoscopic-guided nasopharyngeal biopsy to exclude nasopharyngeal malignancy between 1/2006-10/2013. All medical consultation referral letters were reviewed, and statistical analyses were conducted to evaluate clinically significant predictors (demographics, clinical manife- stations, nasopharyngeal endoscopic findings) for nasopharyngeal malignancy. A total of 470 patients (470 nasopharyngeal biopsies, 54.9% males and 66% smokers) were included. The most common pathological result was adenoid/lymphoid hyperplasia (76.2%). The overall negative rate of all biopsies for malignancy was 94.2%. Twenty-seven patients had nasopharyngeal malignancy: 22 had squamous cell carcinoma and 5 had non-Hodgkin`s lymphoma. Advanced age, cervical mass, and suspicious nasopharyngeal mass were independent risk factors for nasopharyngeal malignancy on univariate and multivariate analyses. Nasopharyngeal biopsy may safely be avoided in adults living in a non-endemic area for NPC who are free of the risk factors of advanced age, the presence of a cervical mass, and suspicious nasopharyngeal mass.