Nasopharyngeal Malignancy Research Articles

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.

The Analysis of Vascular Endothelial Growth Factor Gene Polymorphisms on Clinical and Histopathology Features of Nasopharyngeal Carcinoma

Background: Nasopharyngeal malignancy is the first most common malignancy amongst in ear, nose and throat. Incidence rate was 4.7 per 100.000 or 7.000-8.000 cases per year and most of carcinoma is arising from the epithelial cells. Objective: To analyze the VEGF gene variations at +405 C/G and -460 T/C with VEGFR (Flt-4) and LMP-1 tissues expression of nasopharyngeal carcinoma (NPC). Methods: A cross sectional study was carried out with explorative approached at several teaching hospitals in Makassar by Hasanuddin University Research Centre and Eijkman Institute for Molecular Biology on a one-year period, from July 2006 through August 2007. The analysis covered from 90 samples of blood and 45 samples of nasopharynx tissue, consisting of 45 patients for both of the NPC and without NPC as a control. Genomic DNA was extracted from peripheral blood and analyzed by PCR and direct DNA sequencing method for identifying the location of VEGF gene mutation and immunohistochemical expression of VEGFR (Flt-4) and LMP-1 were performed in 45 NPC biopsy samples with avidin-biotin method. Results: The frequencies of +405 C/G and -460 T/C were about 50%, with higher in +405 C/G (hot spot), mostly genotype variant was heterozygote (CG). Our results confirmed that untranslated and promoter region of VEGF gene were higher polymorphic. GC and CC haplotype at +405 C/G and -460 T/C of VEGF gene more susceptible to NPC compared with CT haplotype but no statistical significant. Conclusion: There were no relationships between genotype distribution and allele frequencies at VEGF gene +405 C/G, -460 T/C and -457 T/C with the NPC risk factors.

18F-FDG Uptake Characteristics in Differentiating Benign from Malignant Nasopharyngeal Lesions in Children

The characteristics of FDG uptake in the physiologic and malignant nasopharynx were investigated in the paper which was correlated with either pathologic findings or clinical follow-up. Three patients had pathologically established nasopharyngeal malignancy. In the 3 nasopharyngeal malignancies, 2 had diffusely and expansively increased FDG uptake, and one had asymmetric uptake. Our results indicated that the difference between adenoid hypertrophy and malignancy is asymmetric or diffusely expansive 18F-FDG uptake with or without correlating morphologic lesion on diagnostic CT in children under 10 years of age. The typical characteristics of physiologic and inflammatory 18F-FDG uptake in nasopharynx are symmetrically trapezoid. Diffusely increased nasopharyngeal FDG uptake can be considered physiologic if SUVmax is less than 7.6 but should be carefully assessed by pharyngorhinoscopy if SUVmax is greater than 11 and there is no correlating morphologic lesion on diagnostic CT. The diffusely, expansively increased uptake, and asymmetric uptake in particular, should be considered as malignancy. Further biopsy is especially indicated in patients with retropharyngeal space and bilateral cervical lymph node abnormality but no history of malignancy.

Nasopharyngeal carcinoma, an analysis of histological subtypes and their association with EBV, a study of 100 cases of Pakistani population

Introduction: Nasopharyngeal carcinoma is the most common nasopharyngeal malignancy. In recent decades, it has attracted world-wide attention because of complex interactions of genetic, viral, environmental and dietary risk factors, with an etiological association with the malignancy. Nasopharyngeal carcinoma (NPC) is a rare cancer throughout the world, with the exception of Southeast Asia, Southern China and North Africa. The Epstein-Barr virus (EBV) was discovered 38 years ago by electron microscopy of cells cultured from Burkitt’s lymphoma tissue by Epstein, Achong, and Barr. EBV infection is a common infection in Pakistan due to poor socioeconomic conditions but its association with Nasopharyngeal Carcinoma is yet to be firmly established in Pakistani population and there is scarce local data available. Methods: A total of 100 consecutive cases of Nasopharyngeal Carcinoma, over a period of three years (2009-2011) were retrieved and reviewed from the pathology files at the Section of Histopathology, Aga khan University Hospital. Morphological sub classification of Nasopharyngeal carcinoma was done according to WHO. For the detection of EBV, LMP1 immunostain was used. Results: Among total of 100 cases, the male to female ratio was 3:1, with an age range of 13-78 yrs and an average age of 42 yrs. Similar to other regions of world, Non-keratinizing Carcinoma (92%) is the commonest sub-type with a distinct bimodal age distribution, followed by Keratinizing Squamous Cell Carcinoma (8%) but there were no cases of Basaloid Squamous Cell Cacinoma. EBV-LMP 1 staining was demonstrated in 75/92 cases (81%), while all cases of Keratinizing Squamous Cell Carcinoma were negative for EBV-LMP 1 staining. Conclusion: Prognostic impact of LMP-1 on Nasopharyngeal carcinoma is still unclear and also there are controversial studies regarding the prognostic effect of EBV on chemotherapy and radiotherapy, it is paramount that EBV positive and EBV negative patients be investigated for response to therapy to establish the importance of EBV association in nasopharyngeal carcinoma patients. The association with EBV is also very important because with ongoing research in the etiological basis of the tumors (associated with EBV) patients may also benefit from emerging immunotherapy used in these tumors. DOI: http://dx.doi.org/10.3126/ajms.v5i4.9592 Asian Journal of Medical Sciences 2014 Vol.5(4); 16-20

Quantitative expression analysis and prognostic significance of the BCL2-associated Xgene in nasopharyngeal carcinoma: a retrospective cohort study

BackgroundNasopharyngeal carcinoma (NPC) is a highly metastatic epithelial malignancy showing high prevalence in Southeast Asia and North Africa. The BCL2-associated X (BAX) gene encodes the most important pro-apoptotic member of the BCL2 family. We have recently shown that BCL2 and BCL2L12, two other members of the same apoptosis-related family, possess significant prognostic value in NPC. The objective of the current study was to analyze BAX mRNA expression in nasopharyngeal biopsies of NPC patients, and to assess its prognostic potential in this disease.MethodsTotal RNA was isolated from 88 malignant and 9 hyperplastic nasopharyngeal biopsies, resected from Tunisian patients. After cDNA synthesis by reverse transcription of polyadenylated RNA, BAX mRNA expression was analyzed using a highly sensitive quantitative real-time polymerase chain reaction (qRT-PCR) method.ResultsLower BAX mRNA levels were detected in NPC biopsies than in hyperplastic nasopharyngeal samples. BAX mRNA expression status was associated with low tumor extent, negative regional lymph node status, and absence of distant metastases. Kaplan-Meier survival analysis demonstrated that patients with BAX mRNA-positive NPC have significantly longer disease-free survival (DFS) and overall survival (OS). In accordance with these findings, Cox regression analysis revealed that BAX mRNA expression can be considered as a favorable prognostic indicator of DFS and OS in NPC, independent of their gender, age, tumor histology, tumor extent, and nodal status. Furthermore, NPC patients without distant metastases are less likely to relapse when their primary tumor is BAX mRNA-positive, compared to metastasis-free patients with a BAX-negative nasopharyngeal malignancy.ConclusionThis is the first study examining the potential clinical utility of BAX as a prognostic tumor biomarker in NPC. We provide evidence that BAX mRNA expression can be considered as an independent favorable prognostic indicator of DFS and OS in NPC.

The Utility of Diffusion-Weighted Magnetic Resonance Imaging for Discriminating and Early Detecting of Nasopharyngeal Carcinoma

Purpose: To study the utility of Diffusion-Weighted Magnetic Resonance Imaging to distinguish among Nasopharyngeal Carcinoma (NPC), lymphoma, tuberculosis and nasopharyngitis which originates in nasopharynx. Materials and Methods: Our hospital’s institutional review board approved this retrospective study. Forty-two patients with early stage NPC, sixteen with lymphoma, eleven with tuberculosis, and twenty-six with nasopharyngitis were included in this retrospectively study. All patients underwent both nasopharynx and skull base region MR Imaging and nasopharyngo-fiberscope biopsy in our hospital, and were finally diagnosed with histopathologically proven (n = 86) and clinical follow-up (n = 9). The Apparent diffusion coefficient (ADC) values were investigated by experienced radiologist, and averaged ADC value of per patient was compared in groups. Mean ADC values between two groups were compared by independent - samples T-test, and one-way Analysis of Variance was used to analyze mean ADC values among four groups. Results: Mean ADC values of malignant nasopharyngeal lesions (early stage NPC and lymphoma) and benign nasopharyngeal lesions (tuberculosis and nasopharyngitis) were (0.708 ± 0.158) and (0.913 ± 0.168) × 10-3 mm2/s respectively (t = 6.05, P < 0.01). Mean ADC values of nasopharyngeal lesions of early stage NPC, lymphoma, tuberculosis and nasopharyngitis were (0.753 ± 0.135), (0.590 ± 0.156), (0.855 ± 0.137), and (0.935 ± 0.179) × 10-3 mm2/s respectively (F = 18.89, P < 0.01), and post multiple comparisons showed that they were all Statistical significance on 0.05 level between NPC, lymphoma, tuberculosis and nasopharyngitis except subgroup tuberculosis and nasopharyngitis (p = 0.55); An ADC value lower than or equal to 0.828 × 10-3 mm2/s was used as threshold for nasopharyngeal malignancy, with a sensitivity 82.8% and specificity of 70.3%. When the same ADC value ≤ 0.828 × 10-3 mm2/s was used as threshold to differentiate early stage NPC from nasopharyngitis, sensitivity and specificity were 78.6% and 69.2% respectively. When an ADC value ≤ 0.681 × 10-3 mm2/s was used as threshold to differentiate lymphoma from early stage NPC, sensitivity and specificity were 81.3% and 71.4% respectively. Conclusion: MR DWI has a potential value in differentiating nasopharyngeal diseases.

Nasopharyngeal malignancy in children be aware!

Nasopharyngeal malignancy in children be aware!

Undifferentiated Nasopharyngeal Malignancy with Immunohistochemical Features of Diffuse Large B Cell Lymphoma and Undifferentiated Carcinoma: A Collision Tumor?

Objective: To describe an unusual presentation of undifferentiated nasopharyngeal malignancy with immunohistochemical features of both diffuse B-cell lymphoma and undifferentiated carcinoma.Methods: Design: Case Report Setting: Tertiary Private University Hospital Patient: OneResults: A 49-year-old female whose initial nasopharyngeal biopsy interpretation was diffuse large B-cell lymphoma underwent three cycles of Rituximab, Cyclophosphamide, Hydroxydaunomycin, Oncovin and Prednisone (R-CHOP). Post-chemotherapy ComputedTomography (CT) scan of the nasopharynx revealed no change in tumor size or appearance. Repeat nasopharyngeal (NP) biopsy findings suggested an epithelial tumor lineage or post chemotherapy reactive mucosal epithelial cells. No residual lymphoma was noted and immunostaining was positive for cytokeratin. The patient underwent 35 fractions of radiotherapy. Re-evaluation by Magnetic Resonance Imaging (MRI) with contrast after four months showed significant tumor shrinkage. Repeat NP biopsy revealed necrotic tissues with foci of high-grade squamous cell carcinoma. Two months after the biopsy, repeat MRI with contrast of the nasopharynx and neck showed increase in the bulk of the nasopharyngeal tumor with inferior extension to the level ofthe orophaynx and possible contralateral involvement. A nasopharyngectomy via left maxillary swing was performed and the final histopathology was undifferentiated carcinoma.Conclusion: Undifferentiated malignancies of the nasopharynx may contain lymphoma or carcinoma and rarely, both lineages in coexistence. In such cases, the possibility of a collision tumor should be considered. Immunohistochemical distinction is important for treatment and prognostication.Keywords: nasopharyngeal carcinoma, undifferentiated tumor, undifferentiated carcinoma, nasopharyngeal lymphoma, collision tumors, immunohistochemistry, Diffuse large B-cell lymphoma,secondary malignancy

Nasopharyngeal Mucosa and Adenoids: Appearance at MR Imaging

To document the magnetic resonance (MR) imaging appearances of benign nasopharyngeal mucosa and adenoids and to correlate quantitative thickness measurements with histologic findings from nasopharyngeal biopsy specimens. MR imaging studies and nasopharyngeal biopsy specimens were analyzed retrospectively in 100 adults (51 men, 49 women) with benign histologic findings; local institutional review board approval and informed consent had been obtained as part of a previous imaging study. At T1-weighted gadolinium-enhanced MR imaging, the nasopharyngeal roof and adenoid was classified as follows: 1, pencil thin, less than 3 mm; 2, smooth thickening, 3 mm or larger; 3, small tags or stripes; or 4, focal adenoid mass with a vertical striped appearance. The posterior and lateral walls were classified as follows: pattern 1, pencil thin, less than 3 mm; pattern 2, mild thickening, 3 mm or larger with moderate enhancement; or pattern 3, thickening with hypoenhancement along the posterior wall. The frequency of these patterns, as well as cysts, symmetry, and pharyngeal recess patency, were documented. Wall thickness was measured and correlated with age, sex, and histologic findings from biopsy specimens by using Spearman rank correlation and Mann-Whitney U tests. In 100 patients, roof patterns 1-4 were identified in 16 (16%), seven (7%), 33 (33%), and 44 (44%); posterior and lateral wall patterns 1-3 were identified in 20 (20%), 55 (55%), and 25 (25%) patients. Symmetry was identified in 95 (95%) patients, cysts in 41 (41%) patients, and pharyngeal recess patency was identified in 24 (12%) of 200 sides. Roof including adenoid thickness was higher in men (P = .05) and correlated inversely with age (P <.01). In 62 (62%) of 100 patients, biopsy specimens contained lymphoid follicles. Roof including adenoid (P = .01) and posterior wall (P = .03) thickness at MR imaging was higher if follicles were identified in biopsy specimens. Nasopharyngeal hyperplasia has typical MR imaging appearances, including stripes in adenoid bulges and symmetry, which may be useful to differentiate this condition from nasopharyngeal malignancy.

Rhinosporidiosis: intraoperative cytological diagnosis in an unsuspected lesion.

Rhinosporidiosis is a disease endemic to South India, Sri Lanka and some areas of the African continent. The nasal lesions can sometimes be confused with nasopharyngeal malignancy. We report here a clinically unsuspected case of rhinosporidiosis, diagnosed correctly by intraoperative FNAC, and later confirmed by histopathological examination.

Endoscopic Assessment of the Nasopharynx: An Objective Score of Abnormality to Predict the Likelihood of Malignancy

We developed an objective endoscopic score of abnormality of the nasopharynx to predict the likelihood of malignancy. A score sheet with 44 variables was developed to objectively quantify the bilateral endoscopic assessment of the nasopharynx. Patients scheduled to undergo nasopharyngeal biopsies were recruited. The nasopharynx was assessed endoscopically, photographed, and scored on 44 variables. The scores were compared to the biopsy results, and predictors of malignancy were modeled with regression analysis. The sensitivity and specificity of the novel scoring system were examined. Seventeen patients had carcinoma, and 60 had a benign lesion or no disease. Patients with a nasopharyngeal malignancy scored significantly higher than did patients with a benign lesion or no disease. No patient with a malignant lesion had a score of less than 12. With a receiver operating characteristic curve area of 0.917, the score demonstrated an excellent ability to discriminate between nasopharynges that were likely or unlikely to contain malignant disease. Independent predictors for both malignant disease and a score greater than 12 were modeled. A cutoff score above 12 on the novel objective endoscopic assessment of the nasopharynx measure was highly predictive of possible malignancy.

Routine nasopharyngeal biopsy in adults presenting with isolated serous otitis media: is it justified?

Nasopharyngeal malignancy accounts for less than 2 per cent of all head and neck cancers. Serous otitis media (SOM) causing deafness is a recognized indicator of nasopharyngeal obstruction and the possibility of a nasopharyngeal malignancy must be considered in all adults. Examination under anaesthesia (EUA) and biopsy of the nasopharynx is routinely undertaken in many centres to rule out nasopharyngeal malignancy in adults with SOM. The purpose of this 10-year retrospective study was to evaluate the case records of all adult cases of SOM, including their presentation, clinical findings, management and nasopharyngeal biopsy results. Eighty-five patients were included in the study. Fifty-nine presented with unilateral SOM and 26 with bilateral SOM. The primary presenting complaint in all cases was hearing loss. A nasopharyngeal mass was documented in 55 patients (69 per cent). Four nasopharyngeal masses were noted to have irregular or exophytic mucosa on flexible nasendoscopy. All patients underwent a EUA of the ears and a nasopharyngeal biopsy. The four patients with suspicious-looking masses were all found to have malignancies (two squamous cell carcinomas, one B-cell non-Hodgkin lymphoma and one adenocarcinoma). Three of these patients presented with unilateral SOM and one with bilateral SOM. All other patients with masses were found to have benign lymphoid hyperplasia. In total, 4.7 per cent of the adults with conductive hearing loss secondary to SOM were found to have a malignancy on nasopharyngeal biopsy. We would advocate a high index of suspicion of a nasopharyngeal tumour in adults presenting with SOM. If a mass is found in the nasopharynx then it should be biopsied. If no mass is found then it is not necessary to biopsy; however, close follow up, with repeat fibre-optic nasendoscopy, is advised.

New viewpoint to histological classification of malignant epithelial tumors of nasopharynx

Malignant tumors of nasopharyngeal epithelium differ clinically depending on the course of disease and applied therapy. They are presented in regard to the sex, age, smoking habits, alcohol usage and nutrition factors. Various studies already showed various etiological-causal links with Epstein-Barr virus (EBV). This leads to diversity of various morphological and histological types of diseases belonging to various classifications. In this work we presented 60 diagnosed and treated cases with malignant tumor of nasopharyngeal epithelium in the Institute for Otorynolaringology and maxillofacial surgery of Clinical Center of Serbia. All of them were pato-histologicaly examined and 24 of them received serological examination in regard to the concept of association between malignant epithelial tumour and EBV. An important correlation between histopathology and serology was found. Finally, the terminology used by WHO classification is not optimal for further histological determination of nasopharyngeal malignancy; therefore we recommend the French classification of C. Micheaua.

Expression of interleukin-18 by nasopharyngeal carcinoma cells: a factor that possibly initiates the massive leukocyte infiltration

Interleukin-18 (IL-18) is a single-chain cytokine that is produced by various cells. With interleukin-12 (IL-12), it synergistically stimulates activated T cells and natural killer (NK) cells to produce interferon-γ (IFN-γ). Nasopharyngeal carcinoma (NPC) is the most common form of nasal and nasopharyngeal malignancy, and in NPC tumor tissues there is an intense leukocyte infiltration comprising predominantly T cells and macrophages. We previously showed an increased expression of IFN-γ in the infiltrating T cells. To identify the cells that provide IL-12 and IL-18 for stimulating the expression of IFN-γ in activated T cells, NPC cell lines CNE-2 and HK-1, as well as biopsies obtained from NPC and control individuals, were examined. CNE-2 and HK-1 cells were found to express messenger RNA encoding IL-18, but not IL-12. Secreted IL-18 was detected in the culture supernatant. Addition of a caspase-1 inhibitor decreased the secretion level, indicating that this IL-18 secretion was caspase-1 dependent. Moreover, the in vitro IL-18 production in NPC cell lines correlated with the NPC tumor cells in situ. NPC tumor cells in the biopsies produced IL-18, as detected by immunohistochemistry and immunofluorescent double staining. In contrast, IL-18 expression was not observed in the control biopsies. We suggest that IL-18 secreted by NPC tumor cells plays a role in initiating the leukocyte infiltration process. IL-18 stimulates T cells and NK cells to produce IFN-γ, which consequently activates macrophages and other immune cells to secrete chemokines to start a leukocyte recruitment cascade.

Malignant tumours of the nasopharynx at Jos University Teaching Hospital, Nigeria

A retrospective epidemiological study of 55 patients who had been histologically diagnosed as having nasopharyngeal malignancy was undertaken at the Jos University Teaching Hospital in the period from December 1988 to November 1998. Jos is at the heart of the middle belt of Nigeria and is made up of peoples of various tribes and religions. The aim of this study was to evaluate the epidemiological factors, clinical presentation, histological pattern and treatment outcome in the patients during the study period. Fewer females were affected than males with a ratio of 1:1.6. Age range was 35-82 years with an average age of 42.19 years. Most of the well documented predisposing factors were absent in this series and the role of smoking and alcohol is unclear. Squamous cell carcinoma (72.7%) was the commonest epithelial malignancy with the incidence of the well differentiated type (WHO type 1) being as high as 34.5%. Rhabdomyosarcoma (14.8%) was the commonest sarcoma. Neck swelling 70.9%, Nasal stuffiness 41.8%, epistaxis 34.5% and pharyngeal mass 25.5% were the commonest symptoms. Treatment and follow-up were unsatisfactory as patients could not afford the cost of radiotherapy and anti-cancer drugs.

Combined VIth and XIIth cranial nerve palsies: a clival syndrome.

In 1947, Godtfredsen1 reported nine patients in whom the spread of nasopharyngeal cancer to the cavernous sinus produced ophthalmoplegia, usually due to abducens palsy and often accompanied by trigeminal neuropathy. In addition, retropharyngeal lymph node involvement near the hypoglossal canal resulted in XIIth nerve damage.1 He concluded that “ophthalmoplegia (most often sixth nerve paresis) and paresis of the twelfth cranial nerve . . . must be regarded as pathognomonic of a malignant neoplasm in the nasopharynx.”1 Awareness of this unusual pattern of cranial neuropathy has aided the diagnosis of cryptic nasopharyngeal cancers, especially before the introduction of computed scanning. However, tumors arising from the mid and lower clivus are ideally located to interrupt these forward-exiting nerves. It is unlikely that damage to both the VIth and XIIth cranial nerves is peculiar to nasopharyngeal malignancy. To investigate the causes of combined VIth and XIIth cranial neuropathies, I reviewed my experience with an …

Somatosensory evoked potentials: a simple neurophysiological monitoring technique in supra-aortal balloon test occlusions.

The aim of this study was to evaluate somatosensory evoked potentials (SEP) as a simple neurophysiological monitoring method in supra-aortal balloon test occlusions (BTO). The 13 patients examined had carcinoma of the larynx (n = 6), nasopharyngeal malignancy (n = 3), sphenoid meningioma (n = 2), mycotic aneurysm (n = 1), and a tumor of the carotid body (n = 1). Transfemoral balloon occlusion of the internal carotid artery was maintained for 30 min and monitored both clinically and by SEP. None of the 13 patients showed neurological deficits or pathological changes in the SEP. No thromboembolic complications occurred during BTO. In 11 cases the cervical vessels could be spared or reconstructed during surgery. No neurological symptoms occurred during the clinical follow-up. One patient died the day after BTO due to cardiac arrest. Neurophysiological monitoring of preoperative BTO using SEP is a technically simple method. A similar method has been shown to have a high sensitivity and reliability in carotid surgery.

Seropositivity, adenoid hypertrophy, and secretory otitis media in adults--a recognized clinical entity.

Otolaryngologic manifestations of AIDS have been described in the past. In this study, I had examined 14 adults with nasal obstruction and mouth breathing. Nine patients also reported deafness--unilateral in three of them and bilateral in six. All of them revealed a mass in the nasopharynx, either on the posterior rhinoscopy or the x-ray neck-lateral view. To exclude nasopharyngeal malignancy, all of the patients underwent examination of the nasopharynx while under general anaesthesia and biopsy. The histopathologic diagnosis in every patient was nonspecific, reactive lymphoid hyperplasia, which has been described in the background of HIV infections. Four were already confirmed HIV-positive and 10 were found positive on the HIV antibody test. A strong association was established between seropositivity, adenoid hypertrophy, and secretory otitis media in adults.

Routine nasopharyngeal biopsy in adult secretory otitis media.

This study was to determine whether routine examination under anaesthesia and nasopharyngeal biopsy in adults presenting with deafness due to secretory otitis media (SOM) is necessary for detection of nasopharyngeal malignancy. Two patient groups were studied. The first comprised 72 adults with SOM. Of these patients, 3 had nasopharyngeal tumours, 2 of whom also had cervical lymphadenopathy. The prevalence of malignancy in patients with SOM but no other suspicious signs was 1/72 (1.4%). The second group comprised 66 patients receiving treatment for nasopharyngeal neoplasms. In this group, 8 patients had SOM at presentation, 7 of whom had other features suspicious of malignancy. SOM as the sole presenting feature of nasopharyngeal malignancy was 1/66 (1.5%). EUA and biopsy of the nasopharynx is a cost effective investigation which continues to be indicated in adults presenting with deafness due to SOM.

上咽頭悪性腫ようの統計的観察

A clinicopathological study was done on 21 cases of nasopharyngeal malignancy seen from 1977 to 1985 at the Department of Head and Neck Diseases, Shikoku Cancer Center Hospital. The male to female ratio was 12 to 9. The age range was 29 to 85 years, with a median age of 70 years. Pathohistological classification showed 14 carcinomas, 6 malignant lymphomas, and 1 rhabdomyosarcoma. The patients were treated with radiation therapy and chemotherapy:the prognosis of malignant lymphoma found to be better than that of carcinoma.