Epipharyngeal tumors

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

Benign tumors[edit | edit source]

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[edit | edit source]

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[edit | edit source]

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[edit | edit source]

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

Early symptoms[edit | edit source]

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[edit | edit source]

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[edit | edit source]

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

Therapy[edit | edit source]

Angiofibroma[edit | edit source]

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

Carcinoma[edit | edit source]

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[edit | edit source]

Resources[edit | edit source]

KLOZAR, Jan, et al. Speciální otorinolaryngologie. 1. edition. Praha : Galén, 2005. 224 pp. ISBN 80-7262-346-X.