Epipharyngeal tumors

The most common epipharyngeal tumors include angiofibroma, carcinoma , malignant lymphoma . Other types of tumors are rare in the nasopharynx.

Benign tumors

Juvenile angiofibroma

It is a polypoid tumor. It occurs mainly in men between the ages of 15 and 25. Most regress during puberty.

Papilloma

lIt grows either exophytically or inverted - locally aggressive

Angioma

Nasopharyngeal cancer

Nasopharyngeal cancer is common in Southeast Asia. It is rare in Europe. It is probably related to EBV exposure , not related to alcohol and cigarette consumption (unlike other head and neck ca).

Histology

There are 3 types of nasopharyngeal cancer:

• type I – squamous cell ca with horn:
  • tendency to local spread (cranial base)
  • less often the formation of metastases (regional and remote)
  • lower chemo- and radiosensitivity
• type II – little differentiated squamous cell ca without horns.
• type III – undifferentiated ca.

Type ll and lll have similar biological properties:

• characteristic lymphocyte infiltration ,
• early regional metastases (cervical nodes - packets),
• formation of distant metastases more often than in other head and neck tumors,
• association with EBV infection (increased anti-EBV antibody titers),
• highly chemo- and radiosensitive .

Clinical picture

The first symptom is usually painless enlargement of the cervical nodes (metastases).

Early symptoms

• From Eustachian tube obstruction (earring, tinnitus - consequence of chronic secretion in the middle ear - otitis media chronica secretorica).
• Nasal obstruction (often unilateral ), epistaxis .

Late symptoms

• Neurological disorders - involvement of the cranial nerves .
• First paresis n. VI and n. V - diplopia and impaired sensitivity in the face.
• In large tumors - paresis of other oculomotor muscles and lateral mixed system .

Diagnostics

• Rhinoepifaryngoscopy,
• neck palpation,
• biopsy ,
• CT , MR - spread to the base of the skull,
• USG - nodal finding,
• Chest X- ray - lung metastases.

Therapy

Angiofibroma

• Surgery - lateral rhinotomy,
• Bleeding - AG supply vessels and their selective embolization.

Carcinoma

The main treatment modality is radiotherapy - primary tumor and cervical nodes bilaterally (even in patients with unproven cervical metastases electively).

• Nasopharyngeal cancer is associated with a high incidence of occult meta in the cervical nodes!
• Chemotherapy - neoadjuvant × concomitant - patients with advanced tumor ( T3 and T4 ) and patients with cervical metastases.

Links

related articles

• Lymphomas
• Oropharyngeal tumors

Resources

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