Reporter: R4 何承宇 Supervisor : VS 林虞軒 台灣耳鼻喉科醫學會105屆 Nasopharyngeal Mucoepidermoid Carcinoma - A Common Entity at an Uncommon Location Reporter: R4 何承宇 Supervisor : VS 林虞軒

Case general profiled Name:吳XX Age: 47 years old Gender: Male Date of OPD visited : 2017/09/20 Past history : denied

Chief Complaint Double vision while looking at right side was found at 9/17 morning.

Present Illness (1) Dizziness without spinning sensation ; no postural-related No headache or other neurological sign, such as weakness, hearing loss, ear fullness, extremities numbness, facial asymmetry, neck stiffness, photophobia or phonophobia Associated symptoms/signs: Weakness(-) Hearing loss(-) Ear fullness (-) Limbs weakness(-) Facial palsy(-)

Brain MRI T1 with contrast A 1.8cm enhancing lesion in right nasopharynx.

Brain MRI

Consult ENT One polypoid lesion was noted at right rosenmuller fossa

Arrange Biopsy (2017-09-22) PATHOLOGICAL DIAGNOSIS: Nasopharynx, biopsy: Lymphoid hyperplasia with a cluster of atypical cells (2017-10-03) PATHOLOGICAL DIAGNOSIS: Nasopharynx, biopsy: Granulation tissue with fibrin deposition and suppurative inflammation

Admission for open diopsy Admission to our ward for deep biopsy (2018-04-18) Frozen : Nasopharynx, right, Rossenmuller fossa, biopsy: Mucoepidermoid carcinoma

Final pathology PATHOLOGICAL DIAGNOSIS: 1.Nasopharynx, right, debulking surgery: Mucoepidermoid carcinoma, low-grade. 2.Nasopharynx, labeled "deep margin", right, debulking surgery: Mucoepidermoid carcinoma, by invasion. Tumor cells are positive for CK7 and p63, but negative for S100 and EBER in situ hybridization.

Mucoepidermoid carcinoma, low-grade Higher proportion of mucous cells to epidermoid cells.

Tumor staging MRI: Tumor (1.8cm)  cT1N0 Neck echo: N0 Abdominal echo / Chest X-ray / Bone scan : M0  cT1N0M0

Treatment  Discussion with patient. At first do operation first  However, severe complication was considered  refer to radiooncologist  Finally, do RT ( Since 2018/6/4)  Finish RT on 2018/8/7

Post Treatment follow up 10/01 Fiberscopy exam: right nasopharynx: grossly smooth, mild necrotic tissue

Discussion To date, there are only 44 adult patients with nasopharyngeal MEC from 9 English-language studies in the literature. No gender preponderance (NPC: 3-fold higher in males compared with females. ) More Local symptoms ( ear stuffness / Nasal obstruction) Less regional (16.7%) or distant metastasis (8.6%) Larger proportion of nasopharyngeal MEC patients present with early stage disease (57.1%), although histologically most tumors (61.8%) are intermediate or high-grade tumors

Discussion-surgical treatment Surgical treatment is the gold standard for MEC, and the challenge is the anotomy. ( Skull base , ICA) lateral rhinotomy transmaxillary swing transoral-palatal lateral infratemporal fossa subfrontal routes Endoscopic approach

Discussion-outcome Data on survival rate for nasopharyngeal MEC is limited due to the small numbers of patients in the studies. The largest patient series of 13 patients reported an overall median survival of 43 months.

Thank you for your attention