Recurrent Nasopharyngeal Carcinoma With Axillary Lymphnode Metastases : A Rare Presentation | 69360
Otolaryngology: Open Access
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Nasopharyngeal carcinoma (NPC)representing about 0.7% of global burden of cancers where as NPC is the most common
cancer of head and neck in Malaysia, South Eastern China, Hong kong and Singapore. Nasopharyngeal carcinoma
has typically metastases to cervical lymphnodes. Majority(>75%) of NPC patients have advanced locoregional disease with
cervical metastases at the time of initial presentation. The common sites of distant metastases are bone, liver, lung and rarely
metastases to axillary nodes. We report the rare presentation of recurrent NPC with axillary lympnode metastases. Our
patient, 44 years old chinese gentleman who was diagnosed to have NPC with initial staging T2N3bM0 could not complete
neoadjuvant chempradiotherapy due to severe oral mucositis. Subsequent surveillance assessments were unremarkable and
after 3 years he has presented with right axillary lymph nodes. Clinical examination revealed radiotherapy changes at the
nasoharynx and absent cervical lymphadenopathy. Fine needle aspiration of nodes showed as metastatic carcinoma. CT scan
showed obliteration of right fossa of Rosenmuller and axillary nodes. PET CT demonstarted right supraclacicular, axillary and
mediatinal lymphnodes and patient has been subsequently referred for palliative chemotherapy.
Conclusion: This case illustartes the fact that, even though NPC is highly radio and chemo sensitive, these patients needs close
follow up for early detection of recurrence and distant metastases. Despite the effectiveness of radiation and chemotherapy
in the mangement of NPC, local or regional failure still occurs. Knowledge of potential mode of spread is not only vital to
surgeons and also must be conveyed to patients for self examination. FDG-PET CT is better than CT in detecting residual or
recurrent disease in NPC.
Associate Professor Sethu Thakachy Subha Current Appointment:,Head of Unit ENT Head & Neck Surgery,Department of Surgery/Otorhinolaryngology Faculty of Medicine & Health Sciences University Putra Malaysia Serdang, Malaysia. Associate Professor Dr.Sethu Thakachy Subha,obtained her MBBS degree from the University of Kerala India in 1989 and MS degree in ENT Head & Neck Surgery from University Malaya,Kuala Lumpur Malaysia in 2002.she has published articles in local and international peer reviewed journals. She has also presented her research papers in various international conferences. She has been serving as reviewer for many reputed medical Journals.