Öz
Nasopharyngeal carcinoma is the most frequent tumor type arising in the nasopharynx. Lymph node metastases are predominantly seen at diagnosis in lymphnode regions of neck. Nasopharynx carcinoma presenting with distant lymphadenopathy (LAP) rather than a prominent nasopharyngeal mass is not common.We describe a 48-year old man admitted to the hospital with cervical and right axillary mass. In physical examination, he had a 3x2cm right axillary lymphadenopathy (LAP) and bilaterally cervical LAPs. An exisional cervical LAP biopsy histopathology revealed undifferentiated carcinoma metastasis. On radiological evaluation, he had bilaterally cervical LAPs and nasopharyngeal thickening and bone metastasis on his right humerus. He was considered as metastatic undifferentiated carcinoma with highly probable primary as nasopharynx carcinoma. He was given chemotherapy. He achieved near complete response. After 4 months of follow-up, he had again second line therapy with near complete remission. In follow-up period, he developed right axillary LAP (3x2,1cm). An exisional biopsy of the right axillary LAP was performed to rule out other etiologies, such as lymphoproliferative disease. Histopathology had similar histopathological properties with the first cervical biopsy giving rise to thought of keratinizing nasopharynx carcinoma metastasis.Axillary LAP might occur rarely in nasopharynx carcinoma. Secondary primary tumors should be also kept in mind while evaluating the cancer patients with an unexpected relapsing pattern especially in those followed-up with remission for a while. Evaluation of the second biopsy material with the first one seems to be helpful in these patients.
Anahtar Kelimeler
Kaynakça
- Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010;127:2893-917
- Yuan JM, Wang XL, Xiang YB, Gao YT, Ross RK, Yu MC. Preserved foods in relation to risk of nasopharyngeal carcinoma in Shanghai, China. Int J Cancer 2000;85:358
- Liebowitz D. Nasopharyngeal carcinoma: the Epstein-Barr virus association. Semin Oncol 1994;21:376
- Liao XB, Mao YP, Liu LZ, et al. How does magnetic resonance imaging influence staging according nasopharyngeal carcinoma compared with computed staging system for Preliminary anatomical and
- Dolcetti R, Menezes J. Epstein-Barr virus and undifferentiated nasopharyngeal carcinoma: new immunobiological and molecular insights on a long- standing etiopathogenic association. Adv Cancer Res 2003;87:127-57
- Chu EA, Wu JM, Tunkel DE, Ishman SL. Nasopharyngeal carcinoma: the role of the Epstein- Barr virus. Medscape J Med. 2008;10:165
- Hou X, Zhang L, Zhao C, et al. Prognostic impact of plasma Epstein-Barr virus DNA concentration on distant metastasis in nasopharyngeal carcinoma]. Ai Zheng 2006;25:785-92
Öz
Nazofarinks bölgesinde en sık saptanan kanser nazofarinks karsinomudur. Genellikle, lenf nodu metastazı tanı anında ve boyundaki lenf nodu bölgelerinde saptanmaktadır. Nazofarinks kanserinde, nazofarinkste de kitle olmadan uzak lenf nodu metastazı saptanması çok sık görülen bir durum değildir. 48 yaşında erkek hasta servikal ve sağ aksiller kitle şikayetiyle hastaneye başvurdu. Fizik muayenede bilateral servikal lenf adenopati (LAP) ve sağ aksiller LAP saptandı. Servikal LAP eksizyonel biyopsi patolojisinde indiferansiye karsinom metastazı gösterildi. Radyolojik değerlendirmede bilateral serviakl LAP, nazofarinkste kalınlaşma ve humerusta kemik metastazı gösterildi. Metastatik indiferansiye karsinom ve primeri nazofarinks olarak kabul edildi ve kemoterapi başlandı. Tama yakın cevap alındı. 4 ay sonra progresyon nedeniyle ikinci basamak tedavi verildi ve tama yakın yanıt elde edildi. Takipte sağ aksiller LAP (3X2.1 cm) gelişmesi üzerine lenfoproliferatif hastalık gibi diğer etiyolojileri ekarte etmek amacıyla eksizyonel biopsi yapıldı. Histopatolojik özelliklerin birinci histopatolojik özelliklerle benzer olması nedeniyle keratinize nazofarinks karsinom metastazı düşünüldü. Aksiller LAP metastazı nazofarinks kanserinde nadiren oluşabilmektedir. Özellikle belli bir süredir remisyonda izlenen kanserli hastaları değerlendirirken beklenmedik nüks paterniyle karşılaşılacak olursa ikincil primer tümörler akılda tutulmalıdır. Bu hastalarda ikinci biyopsinin birinci biyopsi ile beraber değerlendirilmesi faydalı olabilir.
Anahtar Kelimeler
Kaynakça
- Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010;127:2893-917
- Yuan JM, Wang XL, Xiang YB, Gao YT, Ross RK, Yu MC. Preserved foods in relation to risk of nasopharyngeal carcinoma in Shanghai, China. Int J Cancer 2000;85:358
- Liebowitz D. Nasopharyngeal carcinoma: the Epstein-Barr virus association. Semin Oncol 1994;21:376
- Liao XB, Mao YP, Liu LZ, et al. How does magnetic resonance imaging influence staging according nasopharyngeal carcinoma compared with computed staging system for Preliminary anatomical and
- Dolcetti R, Menezes J. Epstein-Barr virus and undifferentiated nasopharyngeal carcinoma: new immunobiological and molecular insights on a long- standing etiopathogenic association. Adv Cancer Res 2003;87:127-57
- Chu EA, Wu JM, Tunkel DE, Ishman SL. Nasopharyngeal carcinoma: the role of the Epstein- Barr virus. Medscape J Med. 2008;10:165
- Hou X, Zhang L, Zhao C, et al. Prognostic impact of plasma Epstein-Barr virus DNA concentration on distant metastasis in nasopharyngeal carcinoma]. Ai Zheng 2006;25:785-92
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Nisan 2013 |
| Yayımlandığı Sayı | Yıl 2013 |