Nasopharyngeal carcinoma: Imaging features of unusual cancer in children

Nasopharyngeal carcinoma (NPC) is a disease of elderly population while the benign adenoidal hypertrophy is the most common cause of a mass in the nasopharynx in pediatrics. NPC is rare in this age group, unfortunately, these tumors tend to be locally advanced by the time they are diagnosed. Our objective is to emphasize that, although rare, NPC does occur in children and can be diagnosed reliably when certain key radiographic features are recognized. From January 2008 to May 2014, 50 pediatric patients presented to our hospital with pathologically proven NPC. The initial radiological studies (CT of 35 patients and MRI of all 50 patients) are retrospectively assessed regarding the nasopharyngeal masses and cervical lymph nodes. All 50 patients had a nasopharyngeal mass. Intracranial extension was detected in 38 cases, 15 of them invaded the central skull base, the other 23 extending along the nerves. The perineural spread along V3 was the commonest in 16 cases followed by V2 in the other 7 cases. Almost all the nasopharyngeal masses showed restricted diffusion with average ADC: 0.7×10−3mm2/sec. Enlarged lymph nodes presented in 47/50 of the cases. Pediatric NPC is generally not suspected clinically until late into the disease process. Awareness that NPC can occur in children should prompt careful evaluation for distinctive radiographic features. Earlier diagnosis may then direct the patient to timely appropriate therapy when these key radiographic features are present and recognized.