105 Nasopharyngeal Mucoepidermoid Carcinoma A Common Entity at

台灣耳鼻喉科醫學會105屆 Nasopharyngeal Mucoepidermoid Carcinoma - A Common Entity at an Uncommon Location Reporter: R 4 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 • A 1. 8 cm enhancing lesion in right nasopharynx. T 1 with contrast

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 (201804 -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 CK 7 and p 63, but negative for S 100 and EBER in situ hybridization.

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

Tumor staging • MRI: Tumor (1. 8 cm) c. T 1 N 0 • Neck echo: N 0 • Abdominal echo / Chest X-ray / Bone scan : M 0 c. T 1 N 0 M 0

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) a. lateral rhinotomy b. transmaxillary swing c. transoral-palatal d. lateral infratemporal fossa e. subfrontal routes f. 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