Open AccessA challenging presentation of invasive nasopharyngeal sarcomatoid carcinoma
Author(s) -
Alexander Yao,
Haroon A. M. Saeed,
Gavin Udall,
Vivek Kaushik,
Lip Wai Lee
Publication year - 2019
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2018-226168
Subject(s) - medicine , sarcomatoid carcinoma , nasopharyngeal carcinoma , neurosurgery , context (archaeology) , chemoradiotherapy , diplopia , induction chemotherapy , radiation therapy , radiology , surgery , pathology , carcinoma , paleontology , biology
Sarcomatoid carcinoma is a rare clinical entity, especially when presenting in the nasopharynx. We describe the first documented case of nasopharyngeal sarcomatoid carcinoma with intracranial extension in a 59-year-old Caucasian man presenting with severe bifrontal headache and diplopia, secondary to left abducens nerve palsy. We highlight some of the major diagnostic challenges and describe its unusual histological appearance. We outline the importance of a multidisciplinary approach to his management, which includes input from the medicine, neurosurgery, Ear, Nose and Throat (ENT), pathology, radiology, oncology and respiratory teams. In the context of limited evidence, we then describe the rationale to proceed with induction chemotherapy followed by concurrent chemoradiotherapy. Although there was a partial response to treatment, it was not sufficient enough to allow subsequent surgical clearance. The plan going forward is to palliate with chemotherapy as and when the disease progresses.